拇展肌止点重建综合治疗拇外翻畸形的疗效分析  

Curative effect analysis of reverse transfer of abductor hallucis tendon for insertion reconstruction in the synthetic therapy for hallux valgus deformity

作　　者：陈艳清 方源[2] 方光荣 王德明 姜凯 CHEN Yan-qing;FANG Yuan;FANG Guang-rong;WANG De-ming;JIANG Kai(Department of Hand Surgery,The No.971 Hospi-tal of Navy,Qingdao 266071,China)

机构地区：[1]海军第九七一医院手外科,山东青岛266071 [2]青岛大学附属医院关节外科,山东青岛266003

出　　处：《中国美容整形外科杂志》2021年第10期592-595,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨拇展肌腱转位重建止点综合治疗拇外翻畸形的临床效果。方法自2014年1月至2019年1月,海军第九七一医院手外科收治65例(104足)拇外翻畸形患者,采用拇展肌腱转位重建止点于拇趾近节基底内侧方关节囊附着处并松解、切断拇收肌,结合切除拇囊炎增厚的滑膜及第一跖骨头增生的骨赘,紧缩缝合内侧关节囊综合手术,石膏固定拇趾伸直位6周。术后随访6~60个月(平均24个月),采用美国足踝外科协会(American Orthopaedic of Foot and Ankle Society,AOFAS)前足评分系统对拇外翻角(hallux valgus angle,HVA)、拇趾外形、拇囊炎及跖骨疼痛、关节活动度、胼胝消失情况进行疗效分析。结果 65例患者切口均一期愈合,无一例感染;拇囊炎、跖骨痛症状均消失,其中52例胼胝消失,13例胼胝较前好转,且均未在其他部位出现新的胼胝,足部外形美观,行走自如,未出现明显并发症。AOFAS评分:术前为(52.35±7.43)分,术后为(82.46±7.71)分,其差异有统计学意义(t=8.99,P<0.01)。HVA术前(36.37°±2.64°),术后(12.32°±2.48°),其差异有统计学意义(P<0.01)。结论拇展肌腱转位重建止点联合拇收肌松解、切断综合手术,操作简单、损伤较小、恢复较快,为治疗拇外翻畸形提供新的选择。Objective To explore the curative effect of reverse transfer of abductor hallucis tendon for insertion reconstruction in the synthetic therapy for hallux valgus deformity. Methods A total of 65 patients(104 feet) with hallux valgus deformity from January2014 to January 2019 were analyzed retrospectively. All patients underwent reverse transfer of abductor hallucis tendon for insertion reconstruction. The adductor hallucis tendon was loosened and resected at joint capsule attachment medial to proximal segment base of hallux.The increased synovium and hypertrophic osteophyte of the first metatarsal head were resected simultaneously. The medial joint capsule was contracted sutured. The plaster fixation of hallux under full extension was maintained for 6 weeks. All patients were followed up for 6 to 60 months, with an average of 24 months. The curative effect was assessed through hallux valgus angle(HVA), shape of hallux,bunion, metatarsal pain, joint range of motion and disappearance of callus by forefoot scoring system of American Orthopaedic of Foot and Ankle Society(AOFAS). Results All incisions were healing by first intention without infections. The symptoms of bunion and metatarsalgia disappeared in all patients. The plantar callus disappeared in 52 patients and improved in 13 patients. The shape of foot was good and walk was normal. No obvious complications occurred. The preoperative AOFAS score was(52.35 ±7.43) and postoperative score was(82.46±7.71). The difference was statistically significant(t=8.99, P<0.01). The HVA was(36.37°±2.64°) before operation and(12.32°±2.48°) after operation(P<0.01). Conclusion The reverse transfer of abductor hallucis tendon for insertion reconstruction combined with adductor hallucis tendon loosen and resection was easy to operate with less injury and fast recovery, which provide an alternative choice for the treatment of hallux valgus deformity.

关 键 词：拇外翻 拇展肌腱 拇收肌腱 肌腱转位 止点重建 

分 类 号：R687.3[医药卫生—骨科学]