改良Scarf截骨术联合Akin截骨术治疗中重度踇外翻的效果评价研究

摘要

目的 评价改良Scarf截骨术联合Akin截骨术治疗中重度踇外翻的临床效果.方法 选取2011年3月—2016年4月于内蒙古包钢医院治疗的中重度踇外翻患者23例(32足)为研究对象,18足行改良Scarf截骨术,14足行改良Scarf截骨术联合Akin截骨术.分别于术前、术后12~14个月测量踇外翻角(HAA)、跖间角(IMA)、近端关节面固定角(DMAA)、胫侧籽骨位置、美国足踝外科协会(AOFAS)第1跖趾关节评分.结果 本组患足术后均未出现踇外翻复发、踇内翻、跖趾关节活动受限、骨不愈合、第1跖骨头坏死等并发症.术后患足HAA、IMA、胫侧籽骨位置、AOFAS第1跖趾关节评分均优于术前(P<0.05),而手术前后患足DMAA比较,差异无统计学意义(P>0.05).结论 改良Scarf截骨术联合Akin截骨术可有效纠正中重度踇外翻畸形,改善患者临床症状.%Objective To assess the clinical efficacy of modified Scarf and Akin osteotomies for moderate to severe hallux valgus.Methods 23 patients (32 feet) with moderate to severe hallux valgus who received modified Scarf and Akin osteotomies in Inner Mongolia Baogang Hospital from March 2011 to April 2016 were selected as the participants,among which 18 feet received modified Scarf osteotomy alone,the other 14 feet received modified Scarf and Akin osteotomies.Hallux abductus angle (HAA),intermetatarsal angle(IMA),distal metatarsal articular angle(DMAA),tibial sesamoid position and the American Orthopedic Foot and Ankle Society(AOFAS) score of the first metatarsophalangeal joint function were measured before surgery and at 12-14 months after surgery,respectively.Results No complications,such as recurrence of hallus valgus,hallus varus,limited motion range of the metatarsophalangeal joint,nonunion,necrosis of the first metatarsal head were observed in all the patients.After surgery,HAA,IMA,tibial sesamoid position and the AOFAS score of the first metatarsophalangeal joint were all improved significantly(P<0.05),but DMAA had no improvement(P>0.05).Conclusion The modified Scarf and Akin osteotomies can correct moderate to severe hallux valgus,and improve the clinical symptoms effectively.