收肌与展肌移位吻接重建前足横弓矫治外翻畸形  

PROCEDURE OF RECONSTRUCTING TRANSVERSE ARCH OF THE FOREFOOT BY TRANSFERING TENDONS FOR CORRECTING HALLUX VALGUS

作　　者：闫行超 刘鉴峰[1] 刘彬[1] 刘志刚[1] 潘月海[1] 贾晓燕[1] 张亚楠[1] 邵江波[1] 

机构地区：[1]吉林大学第一医院手足外科,长春130021

出　　处：《中国修复重建外科杂志》2015年第4期412-415,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨（足母）收肌与（足母）展肌移位吻接重建前足横弓矫治（足母）外翻畸形的疗效。方法回顾分析2010年1月-2014年1月,采用（足母）收肌与（足母）展肌移位吻接重建前足横弓治疗并获随访的28例（40足）（足母）外翻畸形患者临床资料。其中男3例（6足）,女25例（34足）;年龄20～71岁,平均51.7岁。单足16例,双足12例。病程1～30年,平均8.9年。患者均有不同程度（足母）囊炎表现;22足有明显前足横弓塌陷并足底胼胝,8足合并锤状趾畸形。美国足踝外科协会（AOFAS）评分为（59.07±8.49）分。术前X线片示（足母）外翻角（hallux valgus angle,HVA）（33.68±8.10）°,跖间角（intermetatarsal angle,IMA）（15.60±4.07）°。根据Mann（足母）外翻分类标准,轻度9足,中度23足,重度8足。结果术后1例（1足）切口感染,其余切口均Ⅰ期愈合。2例（3足）出现（足母）趾麻木。28例均获随访,随访时间6个月～4年,平均1.8年。末次随访时根据AOFAS评分量表评定疗效：获优24足,良9足,可4足,差3足;优良率为82.5%。末次随访时,HVA为（15.10±5.28）°,IMA为（9.05±2.42）°,AOFAS评分为（86.03±7.45）分,与术前比较差异均有统计学意义（P=0.00）。伴前足横弓塌陷者横弓均有一定程度恢复,足底胼胝消失（14足）或变小（8足）。2例（3足）分别于术后3个月和2个月时外翻复发,无内翻发生。结论（足母）收肌与（足母）展肌移位吻接重建前足横弓矫治（足母）外翻畸形,能减小HVA及IMA,复位脱位籽骨,重建前足横弓,有效恢复前足生理解剖结构及功能。Objective To explore the effectiveness of the procedure of reconstructing the transverse arch of the forefoot by anastomosing adductor hallucis and abductor hallucis tendons in correcting hallux valgus. Methods A retrospective analysis was made on the clinical data from 28 patients（40 feet） with hallux valgus treated with the procedure of reconstructing the transverse arch of the forefoot by anastomosing adductor hallucis and abductor hallucis tendons between January 2010 and January 2014. There were 3 males（6 feet） and 25 females（34 feet）, with an average age of 51.7 years（range, 20-71 years）. The unilateral foot was involved in 16 cases and bilateral feet in 12 cases. The mean disease duration was 8.9 years（range, 1-30 years）. All the cases had pain of the first metacarpophalangeal joint; 22 feet had collapsed transverse arch of the forefoot combined with plantar callus, and 8 feet had collapsed transverse arch of the forefoot combined with hammer toe deformity. American Orthopaedic Foot and Ankle Society（AOFAS） score was 59.07±8.49. Preoperative X-ray showed that the hallux valgus angle（HVA） was（33.68±8.10）°, and the intermetatarsal angle（IMA） was（15.60±4.07）°. According to classification of the hallux valgus by Mann, 9 feet were rated as mild, 23 feet as moderate, and 8 feet as severe. Results Superficial infection of incision occurred in 1 case（1 foot） after surgery, and healing by first intention was obtained in the others. Two cases（3 feet） had numbness in the toes. All of 28 cases were followed up from 6 months to 4 years（1.8 years on average）. Based on the AOFAS score, the results were excellent in 24 feet, good in 9 feet, fair in 4 feet, and poor in 3 feet, and the excellent and good rate was 82.5%. At last follow-up, the HVA, IMA, and AOFAS score were（15.10±5.28）°,（9.05±2.42）°, and 86.03±7.45 respectively, showing significant differences compared with preoperative ones（P=0.00）. The collapsed transverse arch of the forefoot was re

关 键 词：(足母)外翻 前足横弓 (足母)收肌 (足母)展肌 

分 类 号：R687.3[医药卫生—骨科学]