第一跖骨近端开放性截骨联合软组织手术治疗重度拇外翻

Treatment of severe hallux vaigus with osteotomy of proximal part of first metatarsus combined with soft tissue repairing

目的探讨第一跖骨近端开放性截骨钢板内固定联合软组织手术治疗重度拇外翻的疗效。方法自2007年4月至2009年12月共收治第1、2跖骨间夹角（IMA）大于16。的重度拇外翻患者21例（21足），均采用第1跖骨近端开放性截骨钢板内固定联合外侧关节囊松解、内侧关节囊紧缩、拇收肌松解手术治疗。测量患足负重位X线片，并采用美国足踝外科协会Maryland评分标准对疗效进行评定。结果本组患者2l例，术后随访5—36个月，无截骨不愈合或延迟愈合，无感染发生。IMA由术前的24．7°。改善至术后的6．8。。Maryland评分90—100分者16足（76％），80～89分者4足（19％），70—79分者1足（5％），优良率92％。结论第1跖骨近端开放性截骨钢板内固定联合软组织手术治疗重度拇外翻是治疗不合并拇跖关节炎的重度拇外翻的一种较理想的术式，值得临床推广。

Objective TO explore the effect of osteotomy of proximal part of first metatarsus combined with soft tissue repairing for treatment of severe hallux valgus. Methods Totally 21 patients with IMA 〉 16° were received in this study from April 2007 to December 2009. Osteotomy of proximal part of the first metatarsus was performed combined with lysis for lateral joint capsule, crimple for inner joint capsule and adductor pollicis lysis. Then Maryland system from AOFAS was carried out on the X-ray film of weight foot to evaluate the postoperative outcome. Results After 5 to 36 months follow-up, all 21 cases healed primarily without infections. IMA was improved from 24.7°preoperatively to 6.8°postoperatively. Maryland results： 100 points in 16 feet （76%）, 80-89 points in 4 feet （ 19% ）, 70-79 points in 2 feet （5%）, excellent and good results were 92%. Conclusion It is an optimal method of osteotomy of proximal part of the first metatarsus combined with soft tissue repairing for the treatment of severe hallux valgus. It worth spreading in clinic.