老年人拇趾外翻畸形治疗分析

Analysis of the operative treatment of hallux valgus deformity in the geriatric patients

目的观察手术治疗老年人拇趾外翻畸形的疗效,分析老年患者的特殊性及其采取的相应治疗措施。方法自2000年1月～2005年12月实施老年人拇趾外翻矫形术36例,55足;年龄60～79岁,平均66.9岁。根据拇趾外翻角、I跖骨间角、跖拇关节退行性改变程度及患者年龄,选择最佳手术方式矫正拇趾外翻畸形。围手术期处理注重老年人特点和伴随疾病的治疗。结果本组36例手术全部成功,无手术并发症。31例(48足)随访6个月～6年6个月(平均4年1个月),优良率87.5%。术后患足X线摄片与术前片比较:拇趾外翻角平均改善25°;I跖骨间角平均改善7°。结论老年人拇趾外翻畸形保守治疗无效应当采取手术治疗,手术方式和围手术处理应当针对老年人特点。

Objective To observe the effect of operative treatment of hallux valgus deformity in the geriatric patient and to analyse thespecific characteristics of the geriatric patient and the appropriate treatment to be adopted. Methods 36 corrective operations （55 feet） were performed onhalluxvalgusdeformity in geriatric patients. The mean age of the patients was 66.9 years （ranging 60- 79 years）. The best operative method was chosen to correct thehalluxvalgusdeformity according to thehalluxvalgus angle （HVA）, the first inter-metatarsus angle （IMA）, the extent of the degeneration of the metatarsus hallux joint as well as the age of the patient. Specific characteristics of the geriatric patient and their other illnesses should be taken into consideration and treatment during the peri-operative management. Results All of the 36 operations were successful with no complications. 31 cases （48 feet） were followed up for a period between 6 months - 6 years 6 months （mean 4years 1 months）. The rate of excellent and good results was 87.5%. Comparisons made between the post and pre-operation X-ray plates of the troubled feet indicate that a mean 25° improvement was achieved for HVA and a mean 7° improvement for IMA. Conclusions When conservative treatments of the hallux valgus deformity in the geriatric patient prove ineffective, operative treatment should be suggested. The method of operation and peri-operative managements should be applied in accordance with the specific characteristics of the geriatric patient.