改良Keller手术联合可吸收棒治疗中重度老年性外翻的疗效分析

Modified Keller surgery combined with absorbable stick for repair of moderate or severe senile hallux valgus

[目的]回顾分析改良Keller手术联合可吸收棒治疗中/重度老年性母外翻的应用疗效。[方法]对中重度老年性母外翻患者采用改良Keller手术以"V"型截骨方法切除第一跖骨远端、趾骨近段多余骨赘,同时术中紧缩内侧关节囊,切断内收肌,截骨端以可吸收棒交叉固定第一跖趾关节,术后辅以短腿石膏固定4周。[结果]23例(33足),随访6~20个月,平均13个月。患足伤口除2例出现组织液化坏死,后经换药/理疗等处理痊愈,余31足皆一期愈合,1例(1足)诉偶有疼痛外,其他均无不适感,母外翻角(HVA)平均改善(15.89±4.52)°;第1、2跖骨间角(IMA)平均改善(7.90±1.25)°,与术前HVA和IMA相比明显减小,差异有统计学意义(P≤0.05);美国足踝外科协会母趾-跖趾-趾间关节评分由术前的(69.28±6.71)分提高到术后的(93.05±6.72)分(P≤0.05)。[结论]改良Keller手术联合可吸收棒治疗中/重度母外翻的疗效可靠,尤其对老年性患者适用,可避免金属物对软组织的刺激,安全有效,避免了二次手术取出内固定给老年患者带来的痛苦。

[Objective] To analyze the outcome of modified Keller surgery combined with absorbable stick for treatment of moderate or severe senile hallux valgus. [Methods] Twenty-three cases（33 feet） of moderate to severe senile hallux valgus were enrolled in this study and received the modified surgery. The first metatarsal distal and proximal phalanged redundant osteophytes was removed by modified Keller procedure（＂V＂ osteotomy）.Then, the medial joint capsuleis was tightened, adductor muscles was cut and the first metatarsophalangeal joint was cross-fixed with absorbable stick at the bone ends. [Results] The average follow-up time was 13 months（6 to 20 months）. Two feet was found tissue liquefaction necrosis, and recovered after dressing or physiotherapy. Other 31 feet were healed at one stage. One patient complained about pain occasionally.The average improvement of hallux valgus angle（HVA） and IMA were（15.89±4.52）° and（7.90±1.25）°, respectively. The postoperative HVA and IMA significantly decreased compared with preoperation（P≤0.05）. AOFAS toe- toe- toe metatarsal joint score improved from preoperative（69.28±6.71） to postoperative（93.05±6.72）, with significant difference（P≤0.05）. [Conclusion] The efficacy of modified Keller surgery combined with absorbable stick for treatment of moderate or severe hallux valgus is reliable, especially in elderly patients. It can avoid metal stimulation to soft tissues, thus preventing the pain from the second operation to remove internal fixation.