改良Keller手术治疗老年拇外翻的疗效分析  

Result of modified Keller operation treating hallux valgus

作　　者：孔庆宏[1] 赵庆[1] 汤伟忠[1] 王杰[1] 陈一鸣[1] 

机构地区：[1]上海中医药大学附属岳阳中西医结合医院骨伤科,上海200437

出　　处：《临床医药实践》2010年第2X期165-168,共4页Proceeding of Clinical Medicine

摘　　要：目的:探讨改良Keller结合软组织手术矫治拇外翻的方法,并分析其疗效。方法:根据术前与术后对拇外翻畸形的评估,从酌情减少近节趾骨的截除量,结合跖趾关节内侧软组织成形术以及术后早期康复干预三方面改良Keller手术。自1998年5月～2004年5月,对24例(37足)拇外翻患者行改良Keller手术。所有病例均获得完整资料并随访。对畸形矫正程度、疼痛症状及行走功能等三方面评估疗效。患足均于手术前后摄负重位X线片。结果:本组中优20足,良16足,差1足,优良率为97.3%。术前、术后负重位X线片测量,HVA术前(46.47±9.15)°(27°～65°),术后(14.66±2.53)°(10°～23°),差异有统计学意义(P<0.01);IMA术前(14.53±3.46)°(10°～20°),术后(10.12±1.84)°(8°～14°),差异有统计学意义(P<0.05)。结论:改良Keller手术可明显地减少增大的第一跖趾角;软组织成形术又可使第一二跖间角相应缩小。改良Keller结合软组织成形术能有效地改善足部症状、矫正外翻畸形,因此是一个有效的、可靠的手术方式。通过早期康复干预可有效的恢复行走功能、控制并发症。Objective:To investigated the methods of modified Keller operation,combing operation on soft tissue for treatment of hallux valgus,and evaluated the result.Methods:Evidence appraisal of preoperative and postoperative of hallux valgus,it was three aspect of modified Keller operation,grawing downwards to intercepted length of bones of halluxvalgus,operativing on soft tissue to the wall of MP,interfering early rehabilitation of postoperative.From May 1998 to May 2004,37 feet of 24 patients were treated with modified Keller operation. There were all patients who underwent Keller operation in the study.The follow-up period varied from 18 month to 8 year(average 45 month) .From three aspect of rectified deformity,pain symptom,walking function,we evaluated curative effect.The X-ray films of all feet with loading were taken the preoperative and postoperative.Results:In the study,patients rated as excellent or good in 97.3%.We measured the X-ray films of preoperative and postoperative,HVA was(46.47±9.15) °preoperatively,and(14.66±2.53) °postoperatively.IMA was(14.53 ±3.46) °preoperatively,and(10.12±1.84) °postoperatively.There was significant differences between the preoperative and postoperative of HVA and IMA in the group.Conclusion:Modified Keller operation has markedly grown downwards HVA. Operation on soft tissue has grown downwards IMA.Modified Keller operation is a effective and reliable method to improved symptom and deformity of hallux valgus.Functional rehabilitation of combination of TCM with Western medicine controlled postoperative complications better.

关 键 词：拇外翻 改良Keller结合软组织成形术 中西医结合康复 

分 类 号：R687.3[医药卫生—骨科学]