改良McBride手术联合Akin截骨术治疗轻度拇外翻  

Modified McBride procedure with Akin osteotomy to treat mild hallux valgus

作　　者：桂鉴超[1] 王黎明[1] 顾湘杰[2] 张理[1] 蒋逸秋[1] 马昕[2] 王旭[2] 

机构地区：[1]南京医科大学附属南京第一医院关节外科,南京210006 [2]上海华山医院骨科,上海200040

出　　处：《中国骨与关节外科》2010年第5期359-363,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：目的报道改良McBride手术联合Akin截骨术治疗轻度拇外翻的临床效果。方法 2004年6月至2007年12月,共治疗轻度拇外翻36例(拇外翻角≤30°,跖间角≤13°)。采用内侧纵切口,切除第一跖骨头内侧骨赘,松解拇内收肌腱斜头、外侧关节囊和跖籽骨间韧带,于近节趾骨基底行闭式外翻截骨,以克氏针固定截骨处。术后即可负重行走。结果所有病例随访18～41个月,平均25.3个月,未见拇囊炎复发病例。所有患者在术后3～8周(平均4.1周)恢复原工作。术前拇外翻角为28.4°±4.2°,术后为8.6°±1.8°,最后1次随访时,拇外翻角的矫正较术后有所丢失(10.6°±2.1°),但与术前相比,差异仍有显著性(t=22.7,P<0.01)。术前IMA 11.4°±1.8°,术后9.0°±1.7°,最后1次随访时,IMA增大(10.4°±1.9°),但与术前相比,差异有统计学意义(t=2.3,0.01<P<0.05)。术前AOFAS评分为(38.4±7.2)分,最后1次随访时为(89.1±5.8)分,差异具有显著性(t=32.9,P<0.01)。结论 Akin截骨术可以降低软组织手术的复发率,同时缩短术后康复时间。只要严格掌握手术适应证,可以取得优良的手术效果。Objective To report the results of modified McBride procedure combined with Akin osteotomy to treat mild hallux valgus.Methods From June 2004 to December 2007,36 patients with mild hallux valgus（HVA≤30°, IMA≤13°） were treated by the operation.Medial longitudinal incision was routinely used to resect the medial eminence of the first metatarsal head.And the oblique head of the adductor hallucis tendon,lateral capsule together with the metatarsal -sesamoid ligament were released.Proximal phalangeal base closed abduction osteotomy was then performed and fixated by the Kirschner wire.Full foot weight bearing was permitted immediately after surgery.Results All cases were followed up for 18 to 41 months（mean 25.3 months）.No recurrence of hallux valgus occurred.They resumed the previous works at an average of 4.1 weeks postoperatively（range 3 to 8 weeks）.The hallux valgus angles decreased from 28.4°±4.2°to 8.6°±1.8°,and lost some corrections at the final follow-up.But it still remained as low as 10.6°±2.1°,the improvement was significant in comparison with the preoperative level（t=22.7,P0.01 ）.The intermetatarsal angles were 11.4°±1.8°before the surgery,and decreased to 9.0°±1.7°after the surgery,but seemed a little larger（10.4°±1.9°） at the last follow-up,and the difference was statistically significant（t=2.3,0.01P0.05）.The AOFAS hallux scores were significantly improved from 38.4±7.2 preoperatively to 89.1±5.8 at the last follow-up（t=32.9,P0.01 ）.Conclusion Akin osteotomy can decrease the recurrence rate of soft tissue procedure and shorten the recovery time after surgery.The good result can be achieved as long as the indication for the combined procedures is strictly applied.

关 键 词：拇外翻 截骨术 手术疗效 手术方式 

分 类 号：R687.3[医药卫生—骨科学]