Scarf截骨术联合Akin截骨术治疗中重度拇外翻的疗效研究

摘要

目的 探讨Scarf截骨术联合Akin截骨术治疗中重度拇外翻的疗效.方法 选取2012年6月-2015年5月于宁波市第四医院骨科住院治疗的中重度拇外翻患者44例(57足)〔中度拇外翻14例(17足),重度拇外翻30例(40足)〕,均应用Scarf截骨术联合Akin截骨术治疗,术前术后均经X线检查测量拇外翻角(HVA)、第1、2跖骨间夹角(IMA)、远端关节面固有角(DMAA),参照美国矫形足踝协会(AOFAS)评分标准进行疗效评定.结果 44例患者术后随访10~36个月,4例患者发生并发症〔其中2例患者术后第1、2跖骨间切口发生炎性反应,经换药后愈合;1例患者内侧切口边缘皮肤感觉麻木,12个月后复查时症状已缓解;1例患者遗留第1跖趾关节僵硬〕,无复发病例.中重度拇外翻患者最后1次随访时患足负重位X线检查HVA、IMA、DMAA小于术前(P<0.01).AOFAS评分示疗效优33例,良9例,可2例.中重度拇外翻患者术后AOFAS评分高于术前(P<0.01).本组患者非常满意28例,满意13例,一般3例.结论 Scarf截骨术联合Akin截骨术治疗中重度拇外翻能有效纠正畸形,具有良好的疗效和满意度.%Objective To study the efficacy of Scarf combined with Akin osteotomies on moderate and severe hallux valgus.Methods This retrospective study was conducted on 44 patients(57 feet) with moderate and severe hallux valgus〔14 patients(17 feet) with moderate hallux valgus, 40 patients(40 feet) with severe hallux valgus〕 treated by Scarf combined with Akin osteotomies in Department of Orthopaedics,Ningbo Fourth Hospital from June 2012 to May 2015.Hallux valgus angle(HVA),1-2 intermetatarsal angle(IMA) and distal metatarsal articular angle(DMAA) were measured by X-ray examination preoperatively and postoperatively.The efficacy was evaluated in accordance with the American Orthopaedic Foot & Ankle Association(AOFAS) Ankle-Hindfoot Scale.Results The follow-up of 10-36 months showed that 4 of the 44 patients had postoperative complications,specifically,2 had inflammation reaction in the incision between 1-2 metatarsal bones,but were healed by dress changing,1 case was found with skin numbness at the edge of dorsomedial incision,but improved proved by the findings of X-ray examining 12 months later,1 case had stiffness of the first metatarsophalangeal joint;no patients had recurrence;postoperative HVA,IMA and DMAA were significantly improved in patients with moderate and severe hallux valgus found by X-ray examining of the affected foot with the leg in the weight-bearing position during the last follow-up(P<0.01).AOFAS score showed that the treatment efficacy was excellent in 33 cases,good in 9 cases,and fair in 2 cases.AOFAS score increased significantly in those with moderate and severe hallux valgus postoperatively(P<0.01).Twenty-eight patients were very satisfied and 13 were satisfied with the treatment efficacy,only 3 thought it was fair.Conclusion For moderate and severe hallux valgus,Scarf combined with Akin osteotomies can effectively correct the deformity and achieve good therapeutic effect and high patient satisfaction.