拇外翻矫形术后骨不连的原因及治疗策略

Causes and treatment measures for postoperative nonunion after hallux valgus orthopedics

目的总结拇外翻矫形术后骨不连出现的原因及治疗策略。方法 6例拇外翻矫形术后骨不连的患者,其中1例是第一跖骨远端截骨术后骨不连,5例是第一跖骨干及基底截骨术后骨不连。6例均行翻修术（清创＋植骨内固定术）。结果术后切口均一期愈合,患者均获随访,随访时间12～18个月,平均随访15个月,末次随访时,X线检查见截骨端均完全愈合,无畸形及异常活动。结论拇外翻矫形术后引起骨不连的主要原因是局部骨质量差,如骨质疏松;感染导致内固定失效;术中软组织剥离范围大,影响供应跖骨的血运等。治疗策略主要取决于第一跖骨现有短缩程度及合并的软组织病变。

Objective To summarize causes and treatment measures for postoperative nonunion after hallux valgus orthopedics. Methods There were 6 patients with postoperative nonunion after hallux valgus orthopedics, 1 case among them had postoperative nonunion after first metatarsal distal osteotomy, and the other 5 cases had postoperative nonunion after first metatarsal backbone and base osteotomy. All the 6 cases received revision surgery（debridement ＋ bone grafting internal fixation）. Results After surgery, all wound had first stage healing. Follow-up for the patients lasted for 12～18 months, with the average time as 15 months. X-ray examination in the last follow-up showed complete heal in osteotomy end, without malformation or abnormal movement. Conclusion Main cause of postoperative nonunion after hallux valgus orthopedics is poor local bone quality, such as osteoporosis, in fection-induced failed internal fixation, and wide range of soft tissue dissection in surgery, which will influence blood flow for supplying metatarsal bones. Treatment measures are mainly based on first metatarsal shortening degree and complicated lesion in soft tissue.