重塑第一跖趾关节骨形态治疗(足母)外翻

目的评价Keller手术治疗外翻术中重塑第1跖趾关节骨形态的生理活动解剖结构变化。方法2004年4月～2006年11月,采用Keller手术术中重塑第1跖趾关节面骨形态方法治疗外翻11例22足。男3例,女8例;年龄51～73岁。跖趾关节面分型采用Piggot法:型偏斜型17足,型半脱位型5足。外翻角(hallux valgus angle,HVA)24～49°,平均37°;第1跖间角(intermetatarsal angle,IMA)角9.0～13.5°,平均11.5°。结果术后11例22足均获随访6～30个月,平均14个月。参照朱丽华等评定标准:优18足,良3足,差1足。X线片示,14足形成第1跖趾杵臼样假关节,8足假关节面部分咬合。术后HVA7～16°,平均11°;IMA9.0～13.5°,平均11.5°。术后跖趾关节面Piggot法分型:型适合型12足,型偏斜型10足。结论Keller手术中重塑第1跖趾关节骨形态对外翻术后HAV的纠正及症状改善,及关节稳定性有良好改善,减少了术后肌力不足的发生。

TREATMENT OF HALLUX VALGUS BY REMODELING THE BONE AND ARTICULAR MORHPOLOGY OF THE FIRST METATARSOPHALANGEAL JOINT

OBJECTIVE: To evaluate the physiological function and the anatomic structure of the first metatarsophalangeal joint for the patient with hallux valgus after a remodeling operation with the Keller's method. METHODS: From April 2004 to November 2006, the first metatarsophalangeal joints in 11 patients (22 feet) with hallux valgus were remodeled with the Keller's operation. There were 3 males and 8 females, aged 51-73 years. According to the Piggot typing standard, there were 17 feet of type I (deflexion) and 5 feet of type II (semiluxation). The hallux valgus angles (HVAs) were 24-49 degrees (average, 37 degrees). The intermetatarsal angles (IMAs) were 9.0-13.5 degrees (average, 11.5 degrees). The curative effect and the anatomic structure were evaluated by the follow-up and the X-ray examination. RESULTS: All the cases were followed up for 6 to 30 months after operation (average, 14 months). According to the standard of ZHU Li Hua, et al, the results were excellent in 18 feet, good in 3 feet, and poor in 1 foot. The X-ray films showed that the first metatarsophalangeal joint of 14 feet developed mortar-like false articulation, and 8 feet developed partial false articulation. HVAs were 7-16 degrees (average, 11 degrees). IMAs were 9.0-13.5 degrees (average, 11.5 degrees). According to the Piggot typing standard, there were 12 feet of type I (fitter) and 10 feet of type II (deflexion). CONCLUSION: For the patients with hallux valgus, the remodeling of the first metatarsophalangeal joint by the Keller's operation can rectify HVA, improve the stability of the joints, and prevent occurrence of the insufficient muscle strength after operation.