第1跖楔关节融合联合趾Akin截骨治疗中重度外翻的疗效观察  

Efficacy of the first tarsometatarsal arthrodesis combined with Akin osteotomy in the treatment of moderate to severe hallux valgus

作　　者：刁乃成[1] 刘凤岐[1] 杨波[1] 喻飞[1] 马立峰[1] DIAO Naicheng;LIU Fengqi;YANG Bo;YU Fei;MA Lifeng(Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《中华骨与关节外科杂志》2018年第8期588-590,595,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:第1跖楔关节融合是治疗外翻的的重要手段,但单纯应用这一技术尚不能很好地矫正外翻,联合应用Akin截骨有可能解决这一问题。目的:观察第1跖楔关节融合联合趾Akin截骨治疗中重度外翻的临床疗效。方法:回顾性分析2015年1月至2016年12月采用第1跖楔关节融合联合趾Akin截骨治疗中重度外翻31例43足。其中男4例6足,女27例37足;年龄为42~84岁,平均(60.5±8.6)岁。测量术前、术后的HVA角和IMA角,并对患者进行AOFAS跖趾关节评分。结果:31例43足均获得随访,随访时间为12~36个月,平均(20.7±3.3)个月。HVA从术前的37.7°±7.6°改善为术后的10.8°±3.6°(P<0.01)。IMA从术前的14.3°±3.8°,改善为术后的5.8°±2.3°(P<0.01)。AOFAS评分从术前的(48.6±6.8)分改善为术后的(83.5±5.3)分(P<0.01)。术后发生伤口感染1例,延迟愈合1例,未发生其他并发症。末次随访患者无跖楔关节不融合现象发生,无外翻复发出现。结论:第1跖楔关节融合联合趾Akin截骨治疗中重度外翻的治疗效果良好,并不适用于轻度外翻以及不合并第1跖楔关节松弛的患者。Background： Arthrodesis of the first tarsometatarsal joint is an important procedure in the correction of hallux valgus, when combined with Akin osteotomy, it can probably resolve the problem of hallux valgus. Objective： To investigate the clinical efficacy of the first tarsometatarsal arthrodesis combined with Akin osteotomy in the treatment of moderate to severe hallux valgus. Methods： A total of 31 patients（43 feet） with moderate to severe hallux valgus, undertaking the first tarsometatarsal arthrodesis combined with Akin osteotomy from January 2015 to December 2016 in Beijing Friendship Hospital were retrospectively analyzed, including 4 males（6 feet） and 27 females（37 feet） with the mean age of（60.5 ± 8.6）years（range, 42-84 years）. Hallux valgus angle（HVA） and intermetatarsal angle（IMA） before and after surgery were measured, and American Orthopaedic Foot and Ankle Society（AOFAS） scale was used to evaluate metatarsophalangeal joints.Results： Thirty-one patients with 43 feet were followed up for an average of（20.7±3.3） months（range, 12-36 months）. HVA was improved from preoperative 37.7° ± 7.6° to postoperative 10.8° ± 3.6°（P〈0.01）. IMA was improved from preoperative14.3°±3.8° to postoperative 5.8°±2.3°（P〈0.01）. The AOFAS score increased from preoperative 48.6±6.8 to postoperative83.5±5.3（P〈0.01）. Wound infection and delayed union occurred in one patient respectively. The fusion rate was 100% at final follow up, and there was no recurrence of hallux valgus. Conclusions： The first tarsometatarsal arthrodesis combined with Akin osteotomy has good functional outcomes for patients with moderate to severe hallux valgus, however cannot be applied in mild hallux valgus patients and patients without the first tarsometatarsal joint laxity.

关 键 词：外翻 第1跖楔关节 融合 Akin截骨 

分 类 号：R687.3[医药卫生—骨科学]