正常足与外翻足第一序列的测量及其临床意义  

X- ray evaluation of the normal and hallux valgus feet and its clinical values

作　　者：桂鉴超[1] 顾湘杰[2] 侯明夫[1] 马昕[2] 陈劲松[2] 沈海琦[1] 王黎明[1] 

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

出　　处：《中华骨科杂志》2001年第3期137-140,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨外翻的病理、发病机制、分型以及手术方式的选择。方法对正常足 245足和外翻足 141足进行以下参数的测量和统计学分析：外翻角 (HVA)、跖间角 (IMA)、趾间角 (IPA)、近侧关节固角 (PASA)、远侧关节固角 (DASA)、跖楔角 (MCA)。结果外翻组 PASA、 MCA均大于正常组， IPA却小于正常组 ,而两组 DASA比较差异无显著性意义。两组均可见：随着 HVA的增大， IPA减小。外翻组可见： (1)随着 HVA的增大， PASA有增大的趋势，而 IMA无明显的变化规律； (2)IMA增大者， MCA也增大，差异具有统计学意义，而 HVA与 MCA无统计学的联系。结论外翻的病理因素包括： IPA、 PASA及 IMA。外翻可分为六型：Ⅰ型， IPA增大为主， IPA≥ 22°，而 PASA、 IMA均在正常值范围内；Ⅱ型，单纯 HVA增大， HVA≥ 20°，而 IPA、 IMA、 PASA均在正常值范围内；Ⅲ型，以 PASA增大为主， IMA可以正常或轻度增大， PASA≥ 11°，而 IMA≤ 15°；Ⅳ型，以 IMA增大为主，其又可分为两个亚型，Ⅳ a型， 10°≤ IMA≤ 15°，Ⅳ b型， IMA >15°，而 PASA在正常值范围内；Ⅴ型，混合型， IMA >15°， PASA≥ 11°；Ⅵ型，跖趾骨关节炎型。每一型各有不同的发病机制，应采用不同的手术方式。Objective To study the pathology, pathogenesis, classification and the selection of surgical procedure of hallux valgus. Methods Parameters as HVA, IMA, IPA, PASA, DASA, MCA were measured and statistically analysed in X- ray films of 245 normal and 141 hallux valgus feet. Results PASA,MCA of hallux valgus group were larger, but IPA were smaller, than those of normal group. The difference of DASA between the two groups was not significant. HVA became larger while IPA became smaller in all of the two groups. The hallux valgus group had two charicteristics: 1)As HVA became larger, PASA also became larger accordingly, but IMA changed randomly. 2)As IMA became larger, MCA also became larger accordingly, and the difference between them was significant, but HVA and MCA had no statistical relation. Conclusion The pathological factors of hallux valgus include IPA, PASA, IMA. Hallux valgus can be classified into six types:typeⅠ has larger IPA， IPA≥ 22°， with PASA, IMA being normal; typeⅡ has single larger HVA， HVA≥ 20° , with IPA, IMA, PASA all being normal; typeⅢ has predominant larger PASA, with IMA being normal or slight larger, PASA≥ 11° , and IMA≤ 15°； typeⅣ has predominant larger IMA, and can also be divided into two subtypes, subtypeⅣ a, 10°≤ IMA≤ 15°， subtypeⅣ b, IMA >15° , with PASA being normal;typeⅤ is a mixed type, IMA >15°， PASA≥ 11°； typeⅥ has metatarsal- phalangeal osteoarthritis. Each of them has its own particular pathogenesis and should be operated upon by different procedures respectively.

关 键 词：MU外翻 足 人体测量术 摄影测量法 

分 类 号：R682.6[医药卫生—骨科学] R323.72[医药卫生—外科学]