Ludloff截骨治疗中重度拇外翻的临床疗效观察

Clinical results with the Ludloff osteotomy for correction of moderate-to-severe hallux valgus

目的研究Ludloff截骨术对中、重度拇外翻的治疗效果。方法 2007年9月至2008年10月对26例(34足)中、重度拇外翻患者使用Ludloff截骨配合远端软组织手术进行矫形手术治疗,截骨使用螺钉固定。男4例,女22例,年龄48～67岁,平均58岁。术后采用AOFAS评分对患足进行临床功能评价,同时拍负重位足的正侧位X线片进行影像学评价,比较术后AOFAS评分及跖拇角和第一二跖间角的变化,了解患者的满意程度。结果平均随访时间25个月(19～36个月)。在最后一次随访时,31足基本无痛,3足偶有疼痛或轻微疼痛。患者对拇外翻畸形纠正满意。AOFAS评分为从术前的51分(27～65分)提高到术后的88分(72～96分),HVA从术前的31°(21°～42°)改善为10.3°(7°～15°),IMA从术前的17°(16°～23°)改善为术后的7.8°(6°～10°)。23例(31足)患者对治疗效果满意,3例(3足)比较满意。所有患者均对外形满意。没有严重的并发症出现。结论 Ludloff截骨术是治疗中重度拇外翻可靠有效的方法。

Objective To observe the outcomes of Ludloff proximal first metatarsal osteotomy.Methods Twentysix patients（34 feet） with a mean age of fifty-eight years underwent a modified Ludloff proximal first metatarsal osteotomy and a distal soft-tissue procedure at our hospital for the treatment of a moderate-to-severe hallux valgus deformity.The American Orthopaedic Foot and Ankle Society score and weight-bearing radiographs of the foot were assessed preoperatively and after a mean duration of follow-up of twenty-five months.Results The mean American Orthopaedic Foot and Ankle Society score improved significantly（P 0.01） from 52 points preoperatively to 88 points at the time of the most recent follow-up.The average hallux valgus angle improved from 31°preoperatively to 10.3°at follow-up.The average intermetatarsal angle improved from 17°to 7.8°.No severe complication has found.Conclusion Our intermediateterm results demonstrate that the procedure achieves significant correction of moderate-to-severe hallux valgus deformity,significant re- duction in forefoot pain,and significant improvement in functional outcome.This technique is valuable in correction of moderate to severe hallux valgus deformities.