跖趾骨联合手术治疗老年重度外翻畸形

Treatment of elderly severe hallux valgus by metatarsus-phalanx osteotomy

目的探讨跖趾骨联合手术治疗老年重度外翻畸形的临床疗效。方法自2011年6月至2013年8月利用跖趾骨联合手术方法治疗老年性重度外翻患者237例（406足）,有186（268足）例得到随访,男45例（80足）,女141例（188足）;年龄61~86岁,平均78岁。术前、术后、随访时均拍摄足部负重位正、侧位X光片,测量外翻角（hallux valgus angle,HVA）、第1、2跖骨间角（intermetatarsal angle,IMA）、第1跖骨远端关节面角（proximal articular set angle,PASA）。比较术前、术后、末次随访时测量的外翻相关各角度的X线测量值,并结合AOFAS的Maryland第1跖趾关节百分评分法评分观察疗效。结果本组患者随访时间1~4年,平均3.3年;随访时HVA较术前纠正25.6°±3.8°,IMA较术前纠正8.6°±2.4°,PASA较术前纠正4.7°±4.2°。根据AOFAS百分评分法评定,优115例（188足）、良58例（66足）、可13例（14足）。优良率为94.8%。结论利用跖趾骨联合手术治疗老年性重度外翻畸形的临床疗效良好。但有手术相对复杂、需行多段截骨及内固定等缺点。

Objective To evaluate the effect of matarsus-phalanx osteotomy on the elderly severe hallux valgus. Method From June 2011 to August 2013, we treated 237 elderly severe hallux valgus patients（406 feet） and followed up 186 patients（268 feet）. Of them, there were 45 males（80 feet） and 141 females（188 feet）, aged 61 ~ 86, on an average 78 years. Before operation, after operation, and on the final follow-up, the hallux valgus angle（HVA）, intermetatarsal angle（IMA）, and proximal articular set angle（PASA） were measured on radiographs and compared to see their changes. The effect of operation was evaluated with Maryland rating system. Result The follow-up period varied from 1 to 4 years, averaged 3.3 years. The HVA was corrected 25.6°±3.8°, IMA corrected 8.6°±2.4°, and PASA corrected 4.7°±4.2°. The effect of 115 patients（188 feet） was excellent, 58 patients（66 feet） good, and 13 patients（14 feet） relatively good. The excellent-good rate was 94.8%. Conclusion The effect of matarsus-phalanx osteotomy on the elderly severe hallux valgus is good. But the operation is a relatively complicated one, in which more osteotomies and internal fixation have to be adopted.