微创截骨治疗拇外翻合并小趾囊炎

摘要

目的:观察微创截骨矫正术治疗拇外翻合并小趾内翻崎形的临床疗效.方法:自2007年5月至2009年5月,采用微创截骨娇正术治疗拇外翻合并小趾内翻32例(49足),男2例(2足),女30例(47足);年龄23～80岁,平均57岁.手术前后对患者负重正位X线的HAV角(拇外翻角),IM角(第1、2跖骨间角),第4、5跖骨间角,改良第4、5跖骨间角,小趾内翻角及第5跖骨外翻角进行比较;采用拇外翻疗效评定标准从崎形纠正、拇趾跖趾关节活动度、患者满意度等情况对疗效进行评定;同时按照美国足与踝关节协会小趾-跖趾-趾间关节评分系统(AFAS)对手术前后的AFAS评分进行比较.结果:所有患者手术顺利,手术时间30～60 min,平均40 min; 32例均获随访,时间6～24个月,平均13.5个月.术后负重正位X线的HAV角,IM角,第4、5跖骨间角,改良第4、5跖骨间角,小趾内翻角及第5跖骨外翻角均较术前明显减小(P<0.05),术后AFAS评分较术前明显升高(P<0.05).按照上述疗效标准:优33足,良15足,差1足.结论:微创截骨矫正术治疗拇外翻合并小趾内翻具有损伤小、痛苦少、手术时间短、恢复快、矫形满意等优点.%Objective:To investigate the clinical effects of the minimal invasive osteotomy treatment for hallux valgus combined with tailor's bunion deformity.Methods:From May 2007 to May 2009, Forty-nine feet of 32 patients (a mean age of 57 years old) of hallux valgus combined with tailor's bunion deformity were reviewed retrospectively, including 2 males(2 feet)and 30 females(47 feet).All patients were treated by the minimal invasive osteotomy.The axial and lateral films of all feet with loading were taken before and after operation.The hallux abducto valgus angle (HAV), intermetatarsal angle (IM), fourth-fifth intermetatarsal angle (IM 4 to 5),modified fourth-fifth intermetatarsal angle (MIM 4 to 5 ), Metatarsophalangeal-fifth angle (MPA) and lateral deviation of the fifth matatarsal angle (LDA) were compared before and after operation.Therapeutic effects of all the patients were observed after operation, the item including AFAS score and WEN Jian-min's therapeutic effects standard.Results:The average operating time was 40 minutes.All the patients were followed up, and the duration ranged from 6 to 24 months.The HAV angle, IM angle, IM 4 to 5 angle, MIM 4 to 5 angle, MPA angle and LDA angle significantly decreased after operation.The AFAS score significantly raised after operation.According to the criteria, 33 feet got an excellent restlt, 15 good and 1 fair.Conclusion :The minimal invasive osteotomy treatment for hallux valgus combined with tailor's bunion is effective and safe.This method is mini-trauma,less pain and it can make a very soon rehabilitation.This method has widely clinical value.