医源性[足母]内翻的治疗:41例临床效果分析  

The treatment of iatrogenic hallux varus: analysis of clinical effect in 41 cases

作　　者：毛威[1] 张建中[1] 孙超[1] 王显军[1] Mao Wei;Zhang Jianzhong;Sun Chao;Wang Xianjun(Department of Orthopedic Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院骨科,北京100176

出　　处：《中华整形外科杂志》2022年第9期1028-1034,共7页Chinese Journal of Plastic Surgery

摘　　要：目的探讨医源性[足母]内翻适宜的手术方法,以期指导临床治疗的选择。方法回顾性分析2002年4月至2012年5月首都医科大学附属北京同仁医院骨科收治的医源性[足母]内翻患者资料。综合考虑患者各方面因素,分别采用以下几种方式进行[足母]内翻个体化矫治:(1)单纯软组织松解+关节外侧结构重建;(2)反向截骨+软组织松解+关节外侧结构重建;(3)第1跖趾关节融合术;(4)[足母]趾趾间关节融合术。关节外侧结构重建主要包括[足母]长伸肌部分腱固定术和[足母]短伸肌腱固定术。术后随访比较患足手术前后的负重位X线片的[足母]外翻角(HVA)和第1、2跖骨间角(IMA)的改变,以及美国足与踝关节协会(AOFAS)前足评分的变化,并统计患者对术后效果的满意度情况(不满意、一般、满意、非常满意)。正态分布计量资料以x±s表示,手术前后数据的比较采用配对t检验。结果共纳入医源性[足母]内翻患者37例(41足),男2例,女35例,年龄20~77岁。(1)手术方式:7足采用单纯软组织松解+关节外侧结构重建,20足采用反向截骨+软组织松解+关节外侧结构重建,12足采用第1跖趾关节融合术,2足采用[足母]趾趾间关节融合。其中,涉及[足母]长伸肌部分腱固定术3足、[足母]短伸肌腱固定术19足。(2)手术效果分析:术后随访12.5~24.0个月,平均18.1个月。末次随访时影像学分析显示,术后IMA和HVA均较术前得到明显改善[(6.19±2.67)°vs.(2.97±2.03)°;(8.43±1.72)°vs.(-11.50±4.37)°;均P<0.01]。AOFAS评分由术前的(56.39±18.78)分增加至术后的(81.73±6.10)分(P<0.01)。对41患足的满意度调查显示,不满意2足、一般5足、满意28足、非常满意6足,满意率为82.9%(34/41)。结论第1跖趾关节融合术是治疗僵硬性内翻伴关节破坏的标准选择。对于半僵硬及柔性的[足母]内翻矫正,手术操作应以反向截骨术与软组织手术相结合,并根据患者实际情况而各有Objective The therapeutic methods and clinical efficacy of hallux varus were analyzed retrospectively,and further discussion was made to facilitate the selection of clinical treatment.Methods The data of iatrogenic hallux varus patients who accepted surgery operation in Beijing Tongren Hospital from April 2002 to May 2012 were retrospectively analyzed.The conditions of the patients were researched comprehensively,using the following several ways to treat hallux varus deformity respectively:(1)soft tissue release(STR)combined with joint reconstruction of the lateral structure(JRLS);(2)reverse osteotomy(RO)combined with STR and JRLS;(3)metatarsophalangeal joint fusion(MJF);(4)interphalangeal joint fusion.JRLS mainly means hallux longus extensor partial tenodesis and extensor hallucis brevis tenodesis(EHBT).The hallux valgus angle(HVA),1-2 intermetatarsal angle(IMA),and the forefoot scores of American Orthopedic Foot and Ankle Society(AOFAS)were compared before and after procedures.The patients’satisfaction with postoperative outcomes was statistically analyzed(not satisfied,in general,satisfied,very satisfied).Measurement data with normal distribution were expressed as Mean±SD,and comparison before and after operation was performed by paired t-test.Results A total of 37 patients(41 feet)with iatrogenic hallux varus were enrolled,including 2 male and female 35 cases,aged 20-77 years old.(1)Operation method:7 feet of STR combined with JRLS,20 feet in which RO,STR combined with JRLS,12 feet with MJF,2 feet with interphalangeal joint fusion.Involving hallux longus extensor partial tenodesis(3 feet),EHBT(19 feet).(2)Analysis of surgical effect:the mean follow-up was 18.1 months(range,12.5-24.0 months).Depend on the last survey,X-ray analysis showed that IMA and HVA were significantly improved after operation[(6.19±2.67)°vs.(2.97±2.03)°;(8.43±1.72)°vs.(-11.50±4.37)°;all P<0.01].The AOFAS score increased from 56.39±18.78 preoperatively to 81.73±6.10 postoperatively(P<0.01).The satisfaction survey of 41 feet w

关 键 词：足畸形 [足母]内翻 医源性疾病 截骨术 反向截骨 [足母]短伸肌腱固定术 跖趾关节融合术 关节韧带重建 

分 类 号：R687.3[医药卫生—骨科学]