拇外翻矫形后并发症的特殊性  

Specificity of complications after surgical treatment of hallux valgus

作　　者：赵立力[1] 张英泽[2] 宋朝晖[2] 韩久卉[2] 张奉琪[2] 吴昊天[2] 姚双权[2] 

机构地区：[1]邢台市人民医院骨一科,河北省邢台市054000 [2]河北医科大学第三医院创伤急救中心

出　　处：《中国临床康复》2006年第44期29-32,I0001,共5页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:探讨拇外翻术后并发症的起因及防治方法。方法:于1994-03/2004-08选择河北医科大学附属第三医院骨科手术治疗的拇外翻畸形患者113例(186足)进行回顾性分析,其中选择Keller术式67例,Macbride术式56例,Mitchell术式12例,Wilson术式18例,Scarfe术式4例,Loison术式20例,跖趾关节融合术9例。分析并发症原因,参照原术式、症状严重程度和患者要求采取针对性措施。首先保守治疗,无效则再次手术治疗。保守治疗包括理疗、按摩、主被动功能锻炼和支具固定等。手术参照并发症原因采取针对性措施。所有患者按美国足踝外科协会Maryland评分系统中拇跖趾关节评分标准评分,其中疼痛占40分,功能占45分(包括日常生活及体育活动10分,穿鞋情况10分,跖趾关节活动5分,趾间关节活动5分,关节稳定性5分,拇趾有无胼胝5分),外观占15分;90～100分为优,80～89分为良,70～79分为可,低于70分为差。结果:术后2.5～41个月,平均13个月出现并发症,其中拇外翻复发6例,拇内翻3例,转移性跖骨痛10例,截骨处延迟愈合或不愈合3例,第1跖骨头坏死2例及第1趾列活动受限21例。该组患者首次术后评估,优97足(52%),良45足(24%),可31足(17%),差13足(7%),优良率为76%。针对并发症采取保守治疗38例,手术治疗7例,治疗后评估,优111足(60%),良61足(33%),可12足(6%),差2足(1%),优良率为93%。结论:制定个性化治疗方案,出现并发症后进行针对性的康复治疗,可明显提高疗效。AIM： To investigate the causes and preventive methods of postoperative complications of hallux valgus. METHODS： 113 patients （186 feet） with hallux valgus received surgical treatment from March 1994 to August 2004 were selected from the Department of Orthopedics, Third Hospital Affiliated to Hebei Medical University to perform retrospective analysis, including 67 patients treated by Keller method, 56 patients treated by Macbride method, 12 patients treated by Mitchell method, 18 patients treated by Wilson method, 4 patients treated by Scafe method, 20 patients treated by Loison method and 9 patients treated by fusion of metatarsophalangeal joint. To analyze the causes of complications, measures were adopted by referring to the virgin operative method, severity of symptoms and requirements of patients. Patients received expectant treatments firstly, and then surgical treatment was given provided invalid expectant treatment. The expectant treatments included physical therapy, massage, passive and initiative functional exercises as well as fixation with scaffold etc. Corresponding measures were applied in the operation by referring to the causes of complications. All of patients were evaluated by Maryland score system of American Orthopedic Foot and Ankle Society, which included the clinical parameters of pain （40 points） and function （45 points） [daily life and activity limitations （10 points）, footwear requirements （10 points）, metatarsophalangeal joint motion （5 points）, interphalangeal joint motion （5 points）, metatarsophalangeal interphalangeal stability （5 points）, plantar callus related to metatarsophalangeal joints （5 points）, and alignment of hallux （5 points） as well as appearance （15 points）. Patients with a score of 90-100 points were taken as excellent, 80-89 points as good, 70-89 points as fine, while those with the score less than 70 points were taken as poor. RESULTS： Complications were found at 2.5-41 months after operation with an average of 13

关 键 词：拇外翻 矫形外科手术 回顾性研究 

分 类 号：R687[医药卫生—骨科学]