Austin手术治疗拇外翻的远期疗效分析  

Long-term result of Austin surgery for treatment of hallux valgus

作　　者：陈兆军[1] 王正义[1] 林顺福[1] 唐凡启[1] 陈宇明[1] 于益民[2] 牛永力 

机构地区：[1]北京中医药大学第三附属医院骨科,100029 [2]山东省滨州市人民医院骨科 [3]河北省保定市博慧骨病医院

出　　处：《中华骨科杂志》2007年第6期409-412,共4页Chinese Journal of Orthopaedics

摘　　要：目的总结Austin手术治疗拇外翻5年以上长期随访结果，并进行疗效分析。方法利用Austin手术治疗拇外翻患者438例，其中91例176足获得随访，随访时间5-11年，平均7．8年；男12例20足，女79例156足；年龄23-81岁，平均47岁。术前、术后2周、术后5-11年摄负重位X线片，测量拇外翻角（HVA）、第一、二跖骨间角（IMA）、近端关节固定角（PASA）、远端关节固定角（DASA），并观察其变化。分别于术前及术后3-7年在足底应力测试仪上对18例患者36足测量足底应力，并将两组数据进行对比。结果根据Maryland第一跖趾关节百分评分法对所有患者进行评定，优126足（71．6％），良39足（22．2％），可11足（6．3％），优良率为93．8％。HVA较术前纠正14．2°（t=3．207．P〈0．01），IMA较术前纠正7．5°（t=2．304，P〈0．05），PASA较术前纠正8．3°（t=1．976，P〈0．05），DASA较术前纠正0．4°（t=0．216，P〉0．05）。术后第一跖骨头下负重增加，第二、三跖骨头处应力明显减少，第一至第五跖骨头下负重应力值趋于均匀。结论Austin手术截骨方法简单、稳定、不愈合率低、操作易掌握，是治疗第一跖趾关节无骨关节炎的轻、中度拇外翻患者的一种较好的、疗效可靠的手术方式。Objective： To evaluated the result of Austin surgery for treatment of hallux valgus with more than 5 years follow-up. Methods From September 1995 to August 2001, 438 patients with hallux valgus were treated with modified Austin procedure. There were 91 （176 feet） patients gained follow-up. The follow-up period varied from 5 years to 11 years （average 7.8 years）. The X-ray films of all patients were collected preoperatively, two weeks postoperatively and 5-10 years postoperatively. The hallux valgus angle （HVA）, intermetatarsal angle （IMA）, proximal articular set angle （PASA） and distal articular set angle （DASA） were measured and analyzed on radiographs. There were 18 （36 feet） patients in this study were tested with T-SCAN （made in Germany）, and investigated the diversification of the foot pressure measure- ment system before operation and after operation 3-7 years. Results Based on hallux metatarsopha-langeainterphalangeal scale of Maryland rating system, 126 feet （71.6%） were excellent, 39 feet （22.2%） good, 11 feet （6.3%） fair. The rate of excellent or good was 93.8%. The average HVA correction was 14.2° （t=3.207, P〈 0.01 ）, IMA was 7.5° （t=2.304,P〈 0.05）, PASA was 8.3° （t=1.976,P〈 0.05）, and DASA was 0.4° （t= 0.216 ,P 〉0.05 ）, without prominence correction. After operation the bearing ratio of the 1st metatarsal was larger than that of before operation. The pressure under the 2nd and the 3rd metatarsal heads decreased a lot, and the planter bearing ratio became average. Conclusion Austin operation has metatarsus osteotomy simple and stabilization, rapid healing, operation easy. It is a good and reliable operation means for treatment hallux valgus with mild to moderate and their first metatarsophalangeal joints are without signs of osteoarthritis.

关 键 词：拇外翻 骨折固定 内 截骨术 

分 类 号：R686[医药卫生—骨科学]