第一跖骨近端斜楔形截骨联合软组织手术治疗重度拇外翻(1)
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[摘要]目的：探讨第一跖骨近端斜楔形截骨联合软组织手术治疗重度拇外翻的临床疗效。方法：2008年7月～2010年7月对21例重度拇外翻患者采用第一跖骨近端斜楔形截骨，同时对外侧关节囊松解、内侧关节囊紧缩、拇内收肌腱部分切断治疗。测量患足负重X线，采用美国足踝外科协会Maryland的评分方法对患足进行手术前后评定。结果：本组患者21例，术后随访6～24个月，无截骨不愈合及延迟愈合现象。23足无疼痛，1足偶有轻微疼痛。术后Maryland评分：90～100分19足，80～89分4足，70～79分1足，优良率95%。结论：第一跖骨近端斜楔形截骨联合软组织手术治疗重度拇外翻效果可靠，可以推广。
[关键词]拇外翻；截骨术；内固定
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)02-0186-02
Proximal end of the first metatarsal bone wedge osteotomy combined soft tissue surgery to treat severe hallux valgus
FU De-lin,SHA Xiong-tao,TIAN Yan-li,XUE Yi-qun
(Dr. Sha Cosmetic Plastic Surgery & Dental Clinic,Dalian 116011,Liaoning,China)
Abstract: Objective To seek the effect of treating severe hallux valgus by Proximal end of the first metatarsal bone wedge osteotomy combined soft tissue surgery. Methods The time is since July 2008 till July 2010. The group has 21 patients with severe hallux valgus using proximal wedge osteotomy of the first metatarsal bone, at the same time releasing external joint capsule,tightening internal joint capsule , and cutting partia thumb adductor tendon. Measuring patient foot weight bearing X-ray and evaluating of patients before and after foot surgery by the standard of Foot and ankle Surgical Association of Maryland in the United States. Rusults All 21 patients were followed up 6～24 months,no phenomenon of bone stop union or delayed union. After surgery it was reported that 23 feet got no pain and 1 foot got occasional mild pain.Of Maryland after scoring 90～100 by 19 feet, 80～89 by 4 foot and 70～79 by 1 foot.Excellent rate of 95. Conclusion The effect of proximal end of the first metatarsal bone wedge osteotomy combined soft tissue surgery in treatment of severe hallux valgus is reliable and replicable.
Key words:hallux valgus osteotomy;internal fixation
拇外翻是一种常见的足部疾病，Kelikian曾指出拇外翻手术有130余种方法[1]，对于重度的拇外翻第1、2跖间角大于16°，单纯的软组织重建效果不佳[2-5]。笔者通过对第一跖骨近端行斜楔形截骨联合远端软组织手术治疗21例重度拇外翻患者，术后获得较满意的效果，现报道如下。
1 临床资料
本组患者共21例(24足)，均为女性年龄30～48岁，平均年龄39岁。术前根据足负重正位X线片测量拇外翻角(HVA)26°～40°平均33°，第1、2跖间角(IMA)20°～24°平均为22°。21例患者无扁平足、足手术史、无类风湿，无第一跖趾关节骨关节疾病 ......
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