McBride手术联合第1、2跖骨近端截骨治疗拇外翻

Treatment of hallux valgus using Mcbride operation combined with osteotomy of the base of the first and second metatarsi

目的探讨McBride手术联合第1、2跖骨近端截骨治疗拇外翻的疗效。方法在McBride手术基础上,行第1跖骨近端的楔形外翻截骨和第2跖骨近端截骨,第1跖骨截骨处行微型钢板内固定,第2跖骨截骨处不做固定。术后石膏固定4周后即开始逐渐负重功能锻炼。结果26例均获随访,时间12～48个月。40足中优28足,良10足,差2足,优良率95%。与术前比较,拇外翻角平均矫正16.3°±2.2°,第1、2跖骨间夹角平均矫正4.2°±1.8°。无截骨处愈合不良、拇内翻、感染。结论McBride手术重建了足拇指的软组织力量平衡,第1、2跖骨截骨改善了第1跖骨的正常负重、缓解了第2跖骨头的压力,恢复足横弓,是治疗拇外翻的较好术式。

Objective To assess the treatment of hallux valgus with McBride operation combined with osteotomy of the base of the first and second metatarsi.Methods The operation procedure included McBride operation,valgus osteotomy at the base of the first metatarsal and oblique osteotomy at the base of the second metatarsus.The first metatarsus was fixed with minisize plate,and the second metatarsus was not fixed.Gradually functional exercises were permitted with gradual weight bearing after 4 weeks of immobilization with cast.Results 26 cases（40 feet） were followed up for 12～48 months.The results were excellent in 28 feet,good in 10,and poor in 2.The rate of excellent and good results was 95%.The hallux valgus angle was revised 16.3°±2.2°and the intermetatarsal angle（IM 1～2 angle） correction was 4.2°±1.8°.There was no case of delay union,hallux varus and infection.Conclusions McBride operation rebuilds the soft tissue strength balance of hallux,the weight bearing in first metatarsus was meliorated and the compressive stress of second metatarsal was improved,the foot sidelong bow was reconstructed.The combined operation is a good method for treatment the hallux valgus.