微创截骨矫形术治疗[母]外翻  

Minimally invasive osteotomy of hallux valgus

作　　者：王旭 滕兆麟 耿翔 Wang Xu;Teng Zhaolin;Geng Xiang(Department of Orthopaedics,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《中华骨科杂志》2025年第3期192-196,共5页Chinese Journal of Orthopaedics

摘　　要：外翻是足部常见畸形之一,截骨矫形手术可以有效矫正畸形、缓解疼痛。近些年来,[母]外翻微创截骨矫形术因其围手术期优势(切口小、恢复快)和有效性,受到广大医患的关注。与第一、第二代外翻微创截骨技术相比,第三代微创技术具有截骨方便、矫形能力强、内固定牢固等优势,迅速在国内外得到推广。尽管如此,第三代微创技术术后仍会发生神经损伤、转移性跖痛等并发症,因此操作要点和技巧需要临床医生重视。高扭矩的动力系统、便携的术中透视设备以及合适的复位与内固定器械都是手术顺利开展的前提。微创截骨的方式为"V"形或横行(也有学者将横行定义为第四代微创截骨技术),截骨方向一般建议垂直于第二跖骨。利用撬棒等外推跖骨头时应注重三维矫形,内固定置钉时可采用"in-out-in"的方式并避开足背内侧皮神经,采用Akin截骨时应尽量保留对侧皮质的连续性,外侧内收肌的松解和内侧关节囊的紧缩有助于进一步实现软组织平衡,术后良好的包扎与镇痛也是保证治疗效果的重要环节。熟练掌握微创[母]外翻矫形技术需要一定的学习曲线与操作经验,只有严格控制适应证的选择、术前充分评估以及围手术期管理,才能获得理想的疗效。Hallux valgus is one of the common foot deformities.Osteotomy can effectively correct hallux valgus and relieve pain.In recent years,minimally invasive osteotomy for hallux valgus has attracted the attention of doctors and patients due to its perioperative advantages(small incision and fast recovery)and effectiveness.Compared with the first and second generation minimally invasive osteotomy techniques for hallux valgus,the third generation of minimally invasive techniques has the advantages of easy osteotomy,strong correction ability,and stable internal fixation,so it has been rapidly promoted at home and abroad.Although it has been reported that the third generation of minimally invasive techniques has satisfactory therapeutic effects,complications such as nerve damage and metastatic metatarsalgia are reported as well.Therefore,there are many key points and skills in the surgery that deserve attention.A high-torque power system,portable intraoperative fluoroscopy equipment,and appropriate reduction and internal fixation instruments are all prerequisites for the technique.The minimally invasive osteotomy is V-shaped or transverse(some surgeons define the transverse osteotomy as the fourth-generation technique).The direction of osteotomy is recommended to be perpendicular to the second metatarsal.Three-dimensional orthopedics should be paid attention to when extrapolating metatarsal heads such as crowbars,"in-out-in"method can be used to avoid the dorsomedial cutaneous nerve when internal fixation and nail placement,the continuity of the contralateral cortex should be preserved as much as possible when Akin osteotomy is used,the release of the lateral adductor muscle and the tightening of the medial joint capsule are helpful to further achieve soft tissue balance,and good postoperative bandaging and analgesia are also important links to ensure the treatment effect.In summary,it requires a certain learning curve and operational experience to master the minimally invasive technique.Performing surgery according to in

关 键 词：[母]外翻 截骨术 最小侵入性外科手术 

分 类 号：R687.3[医药卫生—骨科学]