选择性跖骨远端截骨治疗中重度外翻  

Selective distal osteotomy of the first metatarsal for treatment of moderate and severe hallux valgus

作　　者：孙建峰[1] 申杨勇[1] 韩斌[1] 陈京峰[1] 吴长喜[1] 李治斌[1] 崇辉[1] 顾敏琪[1] 

机构地区：[1]中国中医科学院西苑医院骨科,北京100091

出　　处：《中国矫形外科杂志》2012年第9期800-802,共3页Orthopedic Journal of China

摘　　要：[目的]探讨选择性跖骨远端截骨治疗外翻的手术适应证、手术方法及疗效。[方法]对2007年3月～2011年1月本院60例(101足)中度及重度外翻进行回顾性分析。双足41例,单足19例。其中女性57例,男性3例;年龄23～81岁,平均62.6岁。[结果]本组60例(101足)均获随访,随访时间6～48个月,平均22个月。参照美国足踝外科协会Maryland跖趾关节百分评分系统,90～100分40例(66足);80～89分16例(30足);70～79分4例(5足);优良率95%。术前HVA 30°～44°,平均36°;术后10.5°～21°,平均15.3°。IMA 13°～18°,平均16°;术后6°～10°,平均8.5°。第1跖趾关节活动度术前0°～30°,平均16°;术后为25°～50°,平均35°。第1跖骨长度较术前减少3～6 mm,平均4.2 mm。[结论]本术式为软组织合并骨性手术,手术方法简单,创伤较小,跖骨头成形充分,术后不需要辅助内固定等优点,是一种值得推广的术式。[ Objective] To retrospectively study and discuss the indications, surgical techniques and outcomes of selective distal osteotomy of the first metatarsal. [ Methods] From March 2007 to January 2011,60 patients （ 101 feet） with hallux valgus received distal osteotomy of the first metatarsal in our hospital, including 57 females and 3 males, with the mean age of 62. 6 years （range, 23 - 81 years） . [ Results ] The followed - up period varied from 6 months to 4 years, with an average of 22 months. All patients were evaluated with the American Orthopaedic Foot and Ankle Society （AOFAS） hallux metatarsophalangeal -interphalangeal scale for the clinical assessment. The excellent result was abtained in 40 （66 feet）, good in 16 （30 feet）, and fair in 4 （5 feet） . The hallux valgus angles decreased from 36 °（30° -44°） to 15.3 ° （ 10. 5 ° -21 °） . The intermetatar- sal angles were 16° （13° - 18°） before surgery, and decreased to 8.5° （6° - 10°） after surgery. The hallux metatarsophalan- geal joint range of motion increased from 16° （0° -30°） to 35° （25° -50°） . The length of the first metatarsals decreasedby 4. 2 mm （3 -6 mm） . [ Conclusion] This technique is of a soft- tissue and bone surgery, which has the advantages of minimal invasion, stable fixation and sufficiently plastic metatarsal head. It should be widely used in the clinical practice.

关 键 词：外翻 跖趾关节 截骨术 

分 类 号：R687.3[医药卫生—骨科学]