（足母）内收肌-（足母）囊筋膜瓣吻合术治疗（足母）外翻的长期疗效  

Long-term outcomes of hallux valgus treated by the suturing of fascial flap of bursa of hallux with the tendon of adductor hallucis

作　　者：包贝西[1] 王显军[1] 赵尔弘[1] 

机构地区：[1]首都医科大学附属北京同仁医院骨科,北京100730

出　　处：《中华骨科杂志》2016年第21期1360-1366,共7页Chinese Journal of Orthopaedics

摘　　要：目的评价（足母）内收肌-（足母）囊筋膜瓣吻合术治疗（足母）外翻的长期临床效果。方法回顾性分析1993年4月至1996年11月采用（足母）内收肌-（足母）囊筋膜瓣吻合术治疗12例（21足）随访时间超过19年的趵外翻患者资料，均为女性患者，手术时年龄为24-56岁，平均（43．6±7．6）岁。术前、术后4年及术后19年摄足X线片，比较（足母）外翻角（hallux valgus angle，HVA）、跖骨间角（intermetatarsal angle，IMA）及胫侧籽骨位置（tibial sesamaid position，TSP）。采用美国足踝外科协会（American Orthopaedic Footand Ankle Society，AOFAS）足蹈趾、跖趾关节、趾间关节功能评分评价前足功能。应用Glynn综合临床评价及Glynn（足母）趾评分对患者满意度进行调查。结果术前HVA平均为30．680±9．710，IMA平均为12．92°±4．02°；术后4年及19年随访时HVA平均为24．62°±7．61°和21．47°±6．52°，IMA平均为7．32°±3．21°和6．15°±2．92°，均较术前减小。患者术前TSP平均为4．46±1．03，术后4年及19年随访时TSP平均为2．01±0．75和1．79±0．62，均小于术前。HVA、IMA、TSP数值术后4年和19年分别与术前比较差异均有统计学意义，术后4年与术后19年比较差异均无统计学意义。术后19年AOFAS评分为75-100分，平均为（92．16±10．22）分。患者术前足底胼胝的发生率为95．2％（20／21），疼痛性胼胝的发生率为85．7％（18／21），术后19年随访时，各跖骨头下胼胝数量均明显减少，仅1足存在第三跖骨头下疼痛性胼胝，其余胼胝均无痛，胼胝的发生率为33．3％（7／21），疼痛性胼胝的发生率为4．7％（1／21），患者远期胼胝发生率显著低于术前。术后19年随访时，Glynn综合临床评价，优16足、良2足、差3足，优良率为88．5％（18／21）；Glynn（足母）趾评价，优18足、良3足，优良率为100％。结论采用（足母�Objective To evaluate the long-term clinical effect of adductor pollicis and pollicis sac fascial flap anastomosis for hallux valgus. Methods Data 12 cases with hallux valgus who who were treated by adductor pollicis and pollicis sac fascial flap anastomosis from April 1993 to November 1996 and were followed up for more than 19 years were retrospectively analyzed. All the patients were female with an average age of 43.6±7.6 years old （range, 24-56 years）. HVA, IMA, and tibial sesamoid position （TSP） were measured by foot X-ray and Compared between presurgery, 4 years postsurgery and 19 years postsurgery. The American Orthopaedic Foot and Ankle Society （AOFAS）, hallux metatarsophalangeal joints, interphalangeal joint function scores were used to evaluatethe foot function. Patient satisfactions were investigated by Glynn＇s comprehensive clinical evaluation and hallux score. Results Average preoperative HVA was 30.68°±9.71°, and average 1st and 2nd IMA was 12.92°±4.02°. Average HVA 4 years and 19 years post-op were 24.62°±7.61° and 21.47°±6.52°, and average 1st and 2nd IMA were 7.32°±3.21° and 6.15°± 2.92°, which were significantly less than those of pre-surgery. Average TSP was 4.46± 1.03, average TSP 4 years and 19 years post-op were 2.01±0.75 and 1.79±0.62, which were significantly less than those of pre-surgery. There was no significant difference between 4 years and 19 years post-op. The incidence of plantar anterior callus was 95.2% （20/.21）; the incidence of pain was 85.7% （18/21）, and the number of the corpus callosum was significantly reduced 19 year post-op. Only 1 foot had painful callus under the head of third metatarsal, and the rest of the corpus callosum were painless; the incidence of the corpus callosum was 33.3% （7/21）; the incidence of pain of the corpus callosum was 4.7% （1/21）; the incidence of pain of the corpus callosum was 4.7%, and patients with long-term improvement of the effect of the corpus callosum was significantly better than preoper

关 键 词：足 (足母)外翻 随访研究 

分 类 号：R682.6[医药卫生—骨科学]