摘要
目的分析第一跖骨头楔形内翻截骨术治疗拇外翻的疗效。方法自1997年9月～2004年8月实施第一跖骨头楔形内翻截骨术治疗拇外翻25例30足。术前于负重位行X线检查，测量拇外翻角平均为28．7°，Ⅰ～Ⅱ跖骨间角平均10．4°，近侧关节固角平均14．4°。按常规治疗拇外翻的手术方法显露跖骨头并切除内侧骨赘；同时按术前X片上划出的截骨线，测量楔形基底宽度，对跖骨头进行楔形内翻截骨，充分纠正拇外翻及近端关节固角。结果随访1-7年，平均4年3个月，25例30足，优19例21足，良6例8足，差1例1足，优良率96．7％。术后无截骨延迟愈合及跖骨头缺血性坏死。术后复查负重位X线片示，近侧关节固角平均为2．3°，平均改善12．1°；拇外翻角平均14．2°，平均改善14．5°；Ⅰ—Ⅱ跖骨间如平均5．6°，平均改善4．8°。结论跖骨头楔形内翻截骨术治疗拇外翻减小了不正常的跖骨远端关节角，纠正了跖骨头关节面的倾斜，消除了拇趾在反向压力下于跖骨头上向外侧倾斜滑落的趋势；使拇仲、屈长肌腱弓弦状滑脱得以恢复，消除拇趾外翻应力，保持矫正效果和足功能；同时能部分矫正跖骨内翻，疗效确切。
Objective To investigate the value of the Reverdin technique for treatment of hallux valgus based on correctran of proximal articuar set angle. Method To analysis hallux valgus treated by reverdin technique retrospectively from September 1997 to August 2004,25 cases 30 feet were undergone Reverdin technique, including 5 male and 20 female, with an average age of 40.0years （from 23 to 55 years）. Reverding operation is unique among the surgical procedures for adility to correct large proximal articular set angle with a medial wedge - type osteotomy of the metatrsal head. Results On the follow - up of 1 to 7 years,patients rated outcomes as excellent or good in 96.7% （29 feet）. There was no complication of delayed union or avascular necrosis of the metatarsal head. Radiographical follow - up： proximal articular set angle averaged 14.4 degrees（range 18- 9degrees）, had apostoperafive averaged value of2.3 degrees, hallux valgus angles 28.7degrees （range36- 21degrees）, had a postoperative value of 14.2 degrees.Intermetatarsal anglesaveraged 10.4 degrees（range 15 - 4degrees）, lind a postoperative value of 5.6degrees. Conclusion Each of hallux valgus has its own particular pathogenesis and should be operated upon by different procedures respectively. Reverdin operation is perfect for pain relief and the correction of the deformity in the young patients without the veidence of osteoarthritis of the first metatarsophangeal joint. It is a perfect procedure for severe hallux valgus patients whose proximal articular setangles are larger, and their first intermetatarsal angles are less thean 15 degrees. The preoperative proximal articular set angle value is the most important factor in hallux valgus evaluation, as well as the seletion of operative techniqus. The normalization of proximal articular set angle safeguards more successes and less recurrences.
