(足母)长伸肌腱移位动力性矫正(足母)外翻畸形

目的探讨长伸肌腱移位动力矫正外翻畸形的机制及临床疗效。方法2004年4月～2006年12月,采用长伸肌腱移位矫治外翻畸形25例38足。其中男2例3足,女23例35足;年龄22～60岁,平均46.3岁。术前外翻角21～45°,平均31.30°;跖间角7～21°,平均12.52°。手术将第1跖骨骨赘凿除,内侧关节囊修复,收肌横头切断,长伸肌腱向内侧移位、止点再造。结果术后外翻角7.30±2.62°,跖间角6.50±2.46°,与术前比较差异均有统计学意义(P<0.05)。术后功能应用美国足踝外科协会趾-跖趾-趾间关节评分系统进行临床评估,优25足,良7足,差6足,优良率84.2%。获随访6～24个月。2足于术后2个月出现内翻,2足术后3个月出现第1跖趾关节活动受限。无外翻畸形复发。结论通过口止母长伸肌腱内移等软组织平衡恢复了第1跖趾关节内、外侧应力,手术操作简便,畸形矫正效果好且不易复发。

DYNAMIA CORRECTION OF HALLUX VALGUS DEFORMITY WITH MUSCULUS EXTENSOR HALLUCIS LONGUS SHIFTING

OBJECTIVE: To discuss the mechanisms and clinical effect of musculus extensor hallucis longus shifting in correcting hallux valgus (HV) deformity. METHODS: From April 2004 to December 2006, 25 cases of HV (38 feet) were treated by musculus extensor hallucis longus shifting. There were 2 men and 23 women, aging from 22-60 years (mean 46.3 years). HV angle was 21-45 degrees (mean 31.30 degrees), intermetatarsal (IM) angle was 7-21 degrees (mean 12.52 degrees). The HV were corrected by cutting osteophyma of the first metatarsal bone, cutting transverse head of adductor pollicis, transferring musculus extensor hallucis longus and reconstructing its insertion. RESULTS: The patients were followed up 6-14 months after operation. HV angle and IM angle were 7.30 degrees +/- 2.62 degrees and 6.50 degrees +/- 2.46 degrees respectively, showing significant differences when compared with before operation (P < 0.05). According to the American Orthopaedic Foot & Ankle Society (AOFAS) score system, the foot function was excellent in 25 feet, good in 7 feet and poor in 6 feet, and the excellent and good rate was 84.2%. Hallux varus occurred in 2 feet after 2 months of operation, metatarsophalangeal joint limitation of motion in 2 feet after 3 months of operation, no HV recurred. CONCLUSION: The HV deforemity can be corrected by shifting the musculus extensor hallucis longus and reconstructing its insertion. It makes stress of metatarsophalangeal joint balance and prevent recurrance of HV deformity.