Akin截骨术联合Scarf截骨术治疗中重度外翻  

Akin combined Scarf osteotomies for moderate and severe hallux valgus

作　　者：李晓东[1] 江汉[1] 江毅[1] 肖联平[1] 郑金鑫[1] 

机构地区：[1]天津市第三中心医院骨科,300170

出　　处：《天津医药》2016年第6期780-783,共4页Tianjin Medical Journal

摘　　要：目的评价Akin 截骨术联合Scarf 截骨术治疗中重度外翻的效果.方法选取中重度外翻患者39例（58 足）,其中12 例（16 足）中度外翻患者采用单独Scarf 截骨术,27 例（42 足）中重度外翻患者采用Scarf 联合Akin 截骨术.手术前、后均行患足X 线片检查,测量外翻角（HVA）、第一二跖骨间角（IMA）和胫侧籽骨位置,记录患者术前术后美国足踝外科学会足功能评分系统（AOFAS）评分.结果手术均顺利完成.每足手术时间45-78min,平均（55.0±6.8）min,术中出血3~20 mL,平均（11.0±5.4）mL.除1 例（1 足）重度外翻患者Akin 截骨处愈合较慢以外,其余患者Scarf 及Akin 截骨处均愈合良好.手术切口2 例（2 足）出现红肿,后自行消退.2 例（2 足）出现趾背内侧麻木,考虑为神经损伤,经3~5 个月好转.本组患者均获得随访,未见外翻复发病例.术后HVA（14.1°±5.3°）、IMA（7.7°±3.8°）和胫侧籽骨位置[（2.58±0.61）级]均低于术前[分别是（39.6°±6.8°）、（18.7°±5.4°）和（4.87±0.59）级],AOFAS 评分高于术前（分：84.4±8.7 vs. 37.3±9.5,P〈0.05）.结论Akin 截骨术联合Scarf 截骨术治疗中重度外翻疗效肯定,矫形效果满意,并发症少, 外翻复发率低,值得临床推广应用.Objective To study the clinical efficacy of Akin combined Scarf osteotomies for moderate and severe hal?lux valgus. Methods Thirty-nine (58 feet) patients received Akin combined Scarf osteotomies, in which 12 patients (16 feet) with moderate hallux valgus received the single scarf osteotomy. Hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position and American orthopedic foot and ankle society score (AOFAS) were measured and compared before and after operation respectively. Results All operations were successfully completed patients were followed up for 8-22 months. The mean operation time was (55.0±6.8) min. The amount of intraoperative bleeding was 3-20 mL with an aver?age of (11.0±5.4) mL. All patients were healed except for a delayed union of Akin on a severe hallux valgus patient. Two cas?es (2 feet) were found inflammation in surgical incision. Two cases (2 feet) were found numbness in dorsal medial side of hal?lux, which was considered nerve damage and improved in 3-5 months. There was no recurrence of hallux valgus in the peri?od of following up. After surgery, HVA (14.1°±5.3°), IMA (7.7°±3.8°) and tibial sesamoid position (2.58±0.61) were signifi?cantly decreased compared with those before operation (39.6° ± 6.8° , 18.7° ± 5.4° and 4.87 ± 0.59, P<0.05). AOFAS score (84.4±8.7) was significantly higher after surgery than that before surgery (37.3±9.5, P<0.05). Conclusion Akin combined Scarf osteotomies can achieve a excellent therapeutic effect for moderate and severe hallux valgus with very few complica?tions and recurrence, which is worth for clinical application.

关 键 词：外翻 Akin截骨 Scarf截骨 

分 类 号：R687.31[医药卫生—骨科学]