内窥镜下手术治疗拇外翻的实验研究

Experimental Study on Arthroscopic Surgery for the Treatment of Hallux Valgus

目的关节镜下行拇外翻手术的可行性及方法。方法采用10具新鲜保留踝关节的足部标本进行模拟手术。首先建立内远背侧入路和内远跖侧入路,以骨磨钻磨除跖骨头内侧的骨赘,再建立内近侧入路,直到最终完全切除。从内远跖侧入路向内近侧入路方向作关节囊的紧缩缝合。建立外远侧入路和外近侧入路,松解外侧关节囊、拇内收肌斜头和跖籽骨韧带。最后,收紧缝合线,拇外翻畸形得到矫正。另外在20具防腐标本上作了进一步解剖学测量。结果全部标本均成功完成手术。早期5例标本手术时间平均为108 min,发生1例肌腱挫伤、2例皮神经损伤、3例关节面软骨轻微损伤。后期5例标本手术时间平均为63 min,未发生任何副损伤。各入路与周围血管、神经、肌腱等结构之间有一定的安全距离。结论内窥镜下手术治疗拇外翻是可行的,并且具有很好的安全性和可靠性。

Objective To study the feasibility and method of the arthroscupic surgery for the treatment of hallux valgus （HAV）. Methods Ten fresh foot specimens with ankle preserved were used for trial surgery. The medial-distal-dorsal portal and the medial- distal-plantar portal were first established, and the osteophyte medial to the metatarsal head was removed using a burr. The medial-proximal portal was then created to facilitate the complete excision of the medial osteophyte. The medial capsular plication was achieved in the direction from the medial-distal-plantar portal to the medial-proximal portal. The lateral-distal portal and the lateral-proximal portal were made to release the lateral capsule, the oblique head of the hallucis adductus muscle and the metatarsal sesamoid ligament. The sutures were finally tightened and the deformity of hallux valgus was corrected. Twenty embahned foot specimens were added for further anatomical measurements. Results The surgery was successfully performed in all specimens. The operating time of the first 5 specimens averaged 108 minutes. The tendon laceration was occurred in 1 specimen, cutaneous nerve injury in 2 specimens, and articular cartilage mild contusion in 3 specimens. The operating time of the later 5 specimens averaged 63 minutes, and no concomitant injury was found. It appeared that all of the portals had relatively safe distances to the surrounding tendons, neurovascular bundles as well as the other vital structures. Conclusion The arthroscopic surgery for the treatment of is HAV fcasibable with higher safety and rehability.