第1、2跖骨间双Endobutton带袢接骨板结合(趾)囊炎切除手术治疗扇形足

First and second metatarsals Endobutton fixation combined with first and fifthFirst fifthbunionectomies for correction of splay footbunionectomies foot

背景：对于扇形足的有效治疗方法目前仍存在争议，常用的截骨手术损伤大、并发症多、疗效不确定。目的：尝试采用双Endobutton带袢接骨板结合软组织手术纠正扇形足，并评价其初期治疗效果。方法：2012年1月至2012年6月，对6例（8足）扇形足患者采用第1、2跖骨间双Endobutton带袢接骨板结合软组织手术，即第1、2跖骨头双Endobutton带袢接骨板固定、囊与趾囊切除、增生骨赘切除和第1、5跖趾关节囊紧缩联合应用于纠正扇形足畸形，评价患足手术前后影像学改变及美国足踝外科协会（American Orthopedic Foot and Ankle Society， AOFAS）评分差异。结果：所有患者均获随访。随访时间12~20个月，平均（17.7±4.8）个月。手术前后外翻角（27.0°±5.1° vs 15.9°±4.2°， P＜0.05）、第1、2跖骨间角（16.3°±3.2° vs 8.3°±1.9°，P＜0.05）和第1、5跖骨头间距[（9.0±1.0）cm vs（8.0±1.0）cm，P＜0.05]改善明显，术后AOFAS评分较术前提高了55.5%[（50.1±8.7）分vs（77.9±7.3）分，P＜0.05]。结论：第1、2跖骨间双Endobutton带袢接骨板结合（趾）囊炎切除手术可以有效纠正扇形足畸形，手术创伤小、术后可早期负重、患足疼痛改善明显、功能提高显著，但远期疗效仍需进一步观察。

Background：The effective treatment for splay foot is still controversial because of large injury, many complications and un-sure curative effect in common osteotomy methods. Objective：To assess the clinical and radiographic outcomes of 1st and 2nd metatarsal Endobutton fixation with 1st and 5th bun-ionectomies in patients with symptomatic splay foot. Methods：From January 2012 to June 2012, 6 adult patients （8 feet） with symptomatic splay foot underwent 1st and 2nd meta-tarsal Endobutton fixation with 1st and 5th bunionectomies. The radiological measurement based on PACS 5.0 system and the American Orthopedic Foot and Ankle Society （AOFAS） score were used for evaluation pre-and post-operatively. Results：The average duration of follow-up was （17.7±4.8） months （range, 12-20 months） in all patients. The postoperative hallux valgus angle, 1st and 2nd intermetatarsal angle, and maximum distance between 1st and 5th metatarsal heads decreased significantly （27.0°±5.1° vs 15.9°±4.2°, 16.3°±3.2° vs 8.3°±1.9°, [9.0±1.0]cm vs [8.0±1.0]cm, P〈0.05）. The AOFAS score was increased by 55.5%（preoperative：50.1±8.7, postoperative：77.9±7.3, P〈0.05）. Conclusion：For symptomatic splay foot, surgical correction by 1st and 2nd metatarsal Endobutton fixation with 1st and 5th bun-ionectomies can effectively restore the normal foot angular relationship, provide satisfactory results with minimal trauma, early postoperative weight-bearing and obvious improvement of foot function. But long-term curative effect still needs fur-ther observation.