改良Youngswick手术治疗合并第1跖楔关节不稳的青中年人外翻  

Effects of transverse arch reconstruction by modified Youngswick osteotomy on young and middle-aged hallux valgus

作　　者：胡令东[1] 郑建森[1] 张军[1] 

机构地区：[1]山东省泰安荣军医院骨科足踝外科,271000

出　　处：《中国矫形外科杂志》2009年第15期1142-1145,共4页Orthopedic Journal of China

摘　　要：[目的]探讨改良Youngswick手术治疗合并第1跖楔关节不稳的青中年人[足母]外翻的疗效。[方法]2005年11月～2008年11月，采用改良Youngswick手术治疗合并第1跖楔关节不稳的青中年人[足母]外翻病人25例36足；年龄22—49岁，平均37．7岁，术中所有患者均行第1跖楔关节内外侧软组织手术；第1跖楔关节不稳的诊断以Lee和Young的外观直接测量法为诊断标准，术前、术后12个月摄负重位X线片，测量[足母]外翻角（HVA），第1跖骨间角（IMA），术前、术后各组数据采用t检验进行统计学处理分析。[结果]22例28足得到随访，最短随访到术后12个月，最长的1例随访到术后27个月，平均随访时间15．9个月，28足第1跖骨截骨部位都获得骨性愈合，足底疼痛性胼胝都有不同程度的减轻或消失，躅外翻角较术前改善15．7°（P〈0．05），第1、2跖骨间角较术前改善5．9°（P〈0．05）；根据顾湘杰等的评价标准，患者主观评价：优16足，良7足，可5足，优良率82．1％。[结论]改良Young—swick手术治疗合并第1跖楔关节不稳的青中年人躅外翻，可以纠正前足横弓的塌陷，短期疗效可靠，并发症少，病人可早期下地负重行走。[ Objective] To evaluate the effect of transverse arch reconstruction by modified Youngswick osteotomy on young and middle -aged hallux valgus. [ Methods ] From November 2005 to November 2008 , 25 female （36 feet） hallux valgus patients with the average age of 37. 7years old （range 22 to 49 years old） were treated surgically. All feet had hypemobility of the first tarsometatarsal joint and collapse of the transverse arch of the foot. In the operation, the first metatarsal head was pushed laterally, downward and rotated downward. Modified McBride procedure was used on the correction for hallux valgus deformity . The X - ray films of all patients were obtained before operation , and 12 months after operation. The hallus valgus angle and intertatarsal angle were measured and analyzed on radiographs . The surgical outcome was evaluated combined with the Gu Xiang - jie＇ s score. All pamameters were statistically analyzed. All cases were followed - up regularly. [ Results ] Twenty -one cases （28 feet） were followed -up for averaged 15.9 month. Hallax valgus angle reduced from 26. 8° ± 1.07° to 11.1°±0. 29°, intertatarsal angle reduced from 14.9°±1.36° preoperatively to 8.3°± 1.19° postoperatively. The painful callus beneath the forefoot was alleviated or diminished obviously in all cases. Based on Gu Xiangjie＇ score , the subjective assessments were given as excellent in 16 feet , good in 7 feet , and fair in 5 feet. The good to excellent result was 82. 1% . [ Conclusion] For the hallux valgus with hypermobility of the first tarsometatarsal joint and transversal arch collapse , modified Youngswick sur- gery can recover the transverse arch , correct first metatarsal adduct abnormality , and regain the weight - bearing function of the first metatarsal head. Modified Youngswick surgery is an ideal choice for young and middle - aged hallux valgus because of less complications and reliable surgery outcomes.

关 键 词：[足母]外翻 第1跖楔关节 截骨术 

分 类 号：R687.3[医药卫生—骨科学]