经内侧切口行外侧软组织松解联合Austin、Akin截骨术治疗中度足母外翻  

Lateral Soft Tissue Release Combined with Austin and Akin Osteotomy Using Medial Approach for the Treatment of Moderate Hallux Valgus

作　　者：张圣兵 张洪涛[2] 钮俊杰 李俊坤[2] 王根林[2] 杨惠林[2] 

机构地区：[1]江苏省无锡市第二中医医院骨科,江苏无锡214121 [2]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《实用骨科杂志》2016年第8期693-696,共4页Journal of Practical Orthopaedics

摘　　要：目的分析经内侧切口行外侧软组织松解联合Austin、Akin截骨术治疗中度足母外翻的临床效果。方法自2013年1月至2015年5月采用经内侧切口行外侧软组织松解联合Austin、Akin截骨术治疗中度足母外翻患者30例33足,其中男2例,女28例;年龄25~73岁,平均（52.6±5.1）岁。术前均拍摄足负重正位X线片并测量足母外翻角（hallux valgus angle,HVA）及第1、2跖骨间夹角（intermetatarsal angle,IMA）的角度,术前参照美国足踝外科协会（American Orthopaedic Footand Ankle Society,AOFAS）前足功能评分系统标准评价患足功能。术后再次测量HVA、IMA及评价AOFAS前足功能变化。所有相关数据使用SPSS 16.0软件进行处理。结果所有病例随访时间6~25个月,平均13.9个月。除1例因出现转移性足底痛二期行第二跖骨远端截骨成形术（Weil截骨术）外,其余患者均对治疗满意。随访期间无患者出现足背麻木、足母内翻或足母外翻复发、转移性跖骨痛、截骨处不愈合等后遗症。HVA由术前（33.5±6.4）°纠正为（11.0±4.5）°,P〈0.05;跖间角由术前（13.6±2.5）°纠正为（7.4±2.3）°,P〈0.05;AOFAS前足评分由术前（39±8.5）分纠正为（87±9.3）分,P〈0.05。结论经内侧切口行外侧软组织松解联合Austin、Akin截骨术治疗中度足母外翻临床效果良好,且具有避免足背侧瘢痕、防止损伤局部皮神经和深部血管的特点。Objective To analyze the therapeutic effect of lateral soft tissue release combined with Austin and Akin osteotomy using medial approach for the treatment of moderate hallux valgus. Methods We retrospectively analyzed 30 patients with 33 feet of moderate hallux valgus who were treated by lateral soft tissue release combined with Austin and Akin osteotomy using medial approach from January 2013 to May 2015. All the patients underwent anteroposterior X-ray images in weight loading of involved feet to measure hallux valgus angle（ HVA） and intermetatarsal angle（ IMA） preoperatively and postoperatively. The function of involved feet were evaluated using front foot scoring system of American Orthopaedic Foot and Ankle Society（ AOFAS） preoperatively and postoperatively. Results All the patients were followed up for an average of 13. 9 months（ ranged from 6 to 25 months）. Only one patient was performed second metatarsal Weil osteotomy due to transferred plantalgia postoperatively,other 29 patients were all very satisfied with the surgery. No dorsalis pedis numbness,hallux varus,metatarsal transferred pain,nonunion or recurrence of hallux valgus was presented. HVA was corrected from（ 33. 5 ± 6. 4） ° preoperatively to（ 11. 0 ± 4. 5） ° postoperatively（ P〈0. 05）. IMA（ from 13. 6 ± 2. 5° to 7. 4 ± 2. 3°,P〈0. 05） and AOFAS score（ from 39± 8. 5 to 87 ± 9. 3,P〈0. 05） were also improved postoperatively. Conclusion Lateral soft tissue release combined with Austin and Akin osteotomy using medial approach is effective in treating moderate hallux valgus. It can also prevent formation of dorsalis pedis scars and damage of local cutaneous nerves and vessels.

关 键 词：内侧切口 软组织松解 截骨术 足母外翻 

分 类 号：R687.3[医药卫生—骨科学]