拇外翻术后再手术的原因分析及处理对策  

Reason exploration and salvage procedures after failed hallux valgus surgery

作　　者：黄加张[1] 马昕[1] 王旭[1] 张超[1] 王晨[1] 张益钧[1] 顾湘杰[1] 陈立[1] 

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《中华骨科杂志》2013年第4期393-397,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨拇外翻术后再手术的原因及临床处理对策。方法回顾性分析2005年12月至2011年12月拇外翻术后再手术的23例患者完整资料，男3例，女20例；年龄28-85岁，平均63．1岁。再手术时间为初次手术后6-06个月，平均27．6个月。分析23例患者躅外翻术后再手术原因，根据患者临床症状、体征及X线片所示选择再手术方式。结果23例拇外翻患者术后再手术原因包括：复发5例，拇内翻2例，转移性跖痛5例，内固定松动7例，内固定断裂4例。再手术方式包括：跖楔关节融合（3例），基底截骨再次行Akin截骨（1例），基底截骨加跖趾关节融合（1例），跖趾关节融合（2例），改良Weil截骨（5例），去除内固定（11例）。术后随访时间6-36个月，平均16．5个月。美国足踝外科协会（AmericanOrthopaedicFootandAnkleSociety，AOFAS）拇趾、跖趾、趾间关节评分从初次术后（65．3±7．5）分改善到再次术后（89．2＋8．9）分；术后患者主观满意度评价，优17例，良4例，可2例，优良率91-3％（21／23）。结论拇外翻术后再手术原因较多，包括复发、拇内翻、转移性跖痛、内固定松动、断裂等。再手术时需仔细分析患者临床症状、体征及X线检查结果选择个性化方案进行治疗。Objective To explore the causes of failed Hallux valgus surgery and its corresponding salvage interventions. Methods The data of 23 patients （3 males, 20 females） who received hallux valgus revision surgeries, from December 2005 to December 2011 was retrospectively analyzed. Their average age was 63.1 years （range, 28-85 years）. The mean follow-up duration of the first operation was 27.6 months （range, 6-96 months）. The reasons for the failed operations were firstly analyzed and appropriate revision procedures were then chosen based on their clinical manifestation, physical examination and X-ray findings. Results The causes of the 23 primarily failed hallux valgus patients included 5 recurrent hallux valgus de- formity, 2 hallux varus, 5 metatarsalgia, 7 internal fixations looseness and 4 internal fixations breakdown. The salvage surgical procedures consisted of 3 first tarsometatarsal joint fusions, 1 of first metatarsal basal osteotomy and Akin osteotomy again after 2 years, 2 of metatarsophalangeal joint arthrodeses and 5 Weil os- teotomies, 11 removals of internal fixation. The remainder 1 patient had combined first tarsometatarsal joint fusions and metatarsophalangeal joint arthrodesis. The mean followup duration was 16.5 months （range, 6-36 months）. The postoperative average American Orthopaedic Foot and Ankle Society （AOFAS） metatarsopha- langeal-interphalangeal scale was 89.2＋8.9, which was 65.3＋7.5 before revision surgeries. Excellence rate was 91.3% （21/23）, with 17 cases whose effect were excellent, 4 good and 2 fair. Conclusion The reasons of failed hallux valgus surgery varied a lot due to the diversities of surgical methods including relapse, varus, metatarsalgia, internal fixation, break and so on. Fully understand of the pathogenesis as well as clinical presentations were critical for surgeons. Appropriate candidate, proper internal fixation material and suitable surgical methods were other assurances for successful hallux valgus treatments. The decision of revision pro

关 键 词：拇外翻 再手术 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]