Scarf截骨联合软组织平衡松解治疗重度拇外翻  

Scarf osteotomy combined with soft tissue balance release for severe hallux valgus

作　　者：张奉琪[1] 张宇 王欣[1] 王晓猛[1] 李彦森[1] 罗子璇[1] ZHANG Feng-qi;ZHANG Yu;WANG Xin;WANG Xiao-meng;LI Yan-sen;LUO Zi-xuan(Department of Foot and Ankle Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China)

机构地区：[1]河北医科大学第三医院足踝外科,河北石家庄050000 [2]华北医疗健康集团邢台总医院骨科,河北邢台054000

出　　处：《中国骨伤》2022年第12期1132-1137,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨Scarf截骨联合软组织平衡治疗重度拇外翻的手术疗效。方法:回顾性分析2019年6月至2021年6月采用Scarf截骨联合软组织平衡手术治疗的38例(50足)重度拇外翻患者的临床资料,男6例(8足),女32例(42足);年龄29~64(54.7±6.8)岁;左侧26足,右侧24足;病程5~23(12.4±3.9)年。比较手术前后拇外翻角(hallux valgus angle,HVA)、第1、2跖骨间角(intermetatarsal angle,IMA)、跖骨远端关节面角(distal metatarsal articular angle,DMAA),观察术后并发症发生情况。术前和末次随访时采用美国足与踝关节协会(American orthopedic foot ankle society,AOFAS)评分评价前足功能恢复情况,采用视觉模拟评分法(visual analogue scale,VAS)评价患者疼痛缓解程度。结果:38例患者(50足)均获随访,时间15~23(18.3±3.2)个月。HVA、IMA、DMAA术前分别为(44.61±3.92)°、(18.74±2.51)°、(12.85±2.11)°,末次随访时为(13.45±2.13)°、(7.83±1.36)°、(7.03±1.39)°,手术前后比较差异有统计学意义(P<0.05)。术后无截骨端延迟愈合或不愈合、内固定断裂或松动、拇内翻等并发症发生。VAS、AOFAS评分别由术前的(6.81±2.14)、(43.6±8.4)分,提高至末次随访时的(1.97±0.78)、(87.6±5.2)分,差异有统计学意义(P<0.01)。末次随访时根据AOFAS评分,优20足,良28足,可2足。结论:Scarf截骨联合软组织平衡松解治疗重度拇外翻具有良好的稳定性和矫形效果,但需注意其学习曲线和术后并发症。Objective:To explore clinical effect of Scarf osteotomy combined with soft tissue balance in treating severe hallux valgus.Methods:Totally 38 patients(50 feet)with severe hallux valux who underwent Scarf osteotomy combined with soft tissue balance surgery from June 2019 to June 2021 were retrospectively analyzed,aged from 29 to 64 years old with an average of(54.7±6.8)years old;26 feet on the left side and 24 feet on the right side;the courses of disease ranged from 5 to 23 years with an average of(12.4±3.9)years.Hallux valgus angle(HVA),intermetatarsal angle(IMA),and distal metatarsal articular angle(DMAA)were compared before and after operation,and postoperative complications was observed.American orthopedic foot ankle society(AOFAS)score before operation and final follow-up was used to evaluate recovery of forefoot function,and visual analogue scale(VAS)was used to evaluate pain relief.Results:Thirty-eight patients(50 feet)were followed up from 15 to 23 months with an average of(18.3±3.2)months.Preoperative HVA,IMA and DMAA were(44.61±3.92)°,(18.74±2.51)°,(12.85±2.11)°,and improved to(13.45±2.13)°,(7.83±1.36)°,(7.03±1.39)°at final follow-up,which had statistical differneces(P<0.05).No delayed union or nonunion of osteotomy end,fracture or loosening of internal fixation,hallux varus occurred.VAS and AOFAS score improved from(6.81±2.14),(43.6±8.4)points before operation to(1.97±0.78),(87.6±5.2)points at final follow-up,which had statistical difference(P<0.01).According to AOFAS at final follow-up,20 feet got excellent result,28 feet good and 2 feet moderate.Conclusion:Scarf osteotomy combined with soft tissue balance release for severe hallux valgus has good stability and corrective effect,but learning curve and postoperative complications should be paid attention.

关 键 词：拇外翻 截骨术 软组织松解 

分 类 号：R687.3[医药卫生—骨科学]