Weil截骨术治疗外翻术后转移性跖痛症  

Weil osteotomy for metastatic metatarsalgia after hallux valgus surgery

作　　者：李静[1] 李鲲[1] 谢鸣[1] 温建民[1] 方真华[1] 黄若昆[1] 赵晶晶[1] 

机构地区：[1]华中科技大学附属普爱医院足踝外科,武汉430030

出　　处：《中华骨科杂志》2014年第10期1024-1029,共6页Chinese Journal of Orthopaedics

摘　　要：目的：探讨外翻术后发生转移性跖痛症的原因及Weil截骨术治疗外翻术后转移性跖痛症的临床疗效。方法回顾性分析2009年7月至2012年1月，采用Weil截骨术治疗27例外翻术后第二至四跖骨头下转移性跖痛症患者资料，男1例，女26例；年龄28~73岁，平均51岁；均为单足发病。跖痛症均发生在外翻术后6~24个月。其中13例采用微创第一跖骨颈楔形截骨术、7例采用Chevron术、5例采用Akin术、2例采用Lapidus术矫正外翻畸形；术后除5例采用Akin截骨患者因未做第一跖骨截骨而未出现跖骨短缩外，其余22例均出现第一跖骨短缩现象。采用美国足踝外科协会（American Orthopaedic Foot and Ankle Society, AOFAS）趾-跖趾-趾间关节评分及视觉模拟评分（visual analogue scale, VAS）评价手术效果，采用足底压力测试仪测试术前及术后足底压力改变。结果术后25例获得完整随访，随访时间12~48个月，平均24个月。23例跖痛完全消失；2例术后再次出现外侧跖骨头转移性跖痛症，其中1例经垫前足减压垫后疼痛缓解，1例再次行Weil截骨术后疼痛消失。患者术前AOFAS趾-跖趾-趾间关节评分、VAS评分分别为（46.82±6.13）分和7.5（6，7）分，术后末次随访时分别为（90.63±1.65）分和0.5（0，1.0）分。末次随访根据AOFAS趾-跖趾-趾间关节评分，其中23例为优，1例为良，1例为可；优良率为96%（24/25）。手术前、后足趾推进期趾及第二至五趾跖骨头下压力，术前依次为（3.12±1.62）Pa、（5.81±1.92）Pa、（4.63±2.10）Pa、（3.37±1.57）Pa、（1.67±1.20）Pa，术后依次为（3.33±1.35） Pa、（3.89±1.08）Pa、（3.65±1.96）Pa、（2.25±1.23）Pa、（1.48±1.11）Pa；术后跖骨头下压力较术前明显降低。结论 Weil截骨术可有效调节跖骨长度和跖骨头高度，改善疼痛跖骨头下应力，对治疗外翻术后转移性跖痛症有良好�Objective To investigate the cause of metastatic metatarsalgia after hallux valgus surgery and the clinical outcomes of Weil osteotomy for metastatic metatarsalgia after hallux valgus surgery. Methods From July 2009 to Janurary 2012, data of 27 patients （27 feet） with metastatic metatarsalgia of 2nd to 4th head of metatarsal bone after hallux valgus surgery who had been treated by Weil osteotomy were retrospectively analyzed. There were 1 male and 26 females with an average age of 51 years （range, 28-73 years）. Metatarsalgia occurred 6-24 months after operation for hallux valgus. 13 feet underwent mini-invasive cervi-cal wedge osteotomy of the first metatarsal, 7 with Chevron procedure, 5 with Akin procedure, and 2 with Lapidus procedure. No shortening in first metatarsal was found in 5 feet with Akin osteotomy, while there were varying degrees of shortening in first meta-tarsal in the remaining 22 feet. The clinical results were evaluated by American Orthopaedic Foot and Ankle Society （AOFAS） and visual analogue scale （VAS） scores. The preoperative and postoperative plantar pressure changes were tested by plantar pressure tester. Results 25 Patients were followed up for 12-42 months （average, 24 months）. Among these 25 cases, the metatarsalgia of 23 cases were completely disappeared. The metatarsal plantar lateral metastatic pain occurred in the remaining 2 cases （2 feet） and 1 was relieved by the foot pad, 1 was cured by re-Weil osteotomy. AOFAS score was 46.82 ± 6.13 before surgery and 90.63 ± 1.65 after surgery. The VAS score was 7.5 （6, 7） before surgery and 0.5 （0, 1.0） after surgery. The last follow-up, according to the score of AOFAS toe metatarsophalangeal-interphalangeal joint, of which 23 cases were excellent, 1 good, 1 poor;the excellent and good rate was 96%（24/25）. Preoperative pressure under 2nd to 5th metatarsal head were 3.12±1.62 Pa, 5.81±1.92 Pa, 4.63± 2.10 Pa, 3.37±1.57 Pa, 1.67±1.20 Pa and postoperative were 3.33±1.35 Pa, 3.89±1.08 Pa, 3.65±1.96 P

关 键 词：跖痛症 [足母]外翻 截骨术 外科手术 

分 类 号：R687.3[医药卫生—骨科学]