Reverdin手术联合第一跖骨近端截骨治疗外翻

Treatment of Hallux Valgus Using Reverdin Operation Combined with Osteotomy of Proximal First Metatarsal

目的 :探索一种治疗外翻效果较满意的术式。方法 :作者对外翻的传统术式进行了思考 ,运用Reverdin手术联合第一跖骨近端截骨治疗外翻。自 1997年 10月～ 2 0 0 0年 9月 ,13例患者 ,2 1足接受此种手术治疗。术中常规松解软组织及切除内侧骨赘后 ,以Reverdin术式对跖骨头内翻截骨校正近端关节固定角 ,第一跖骨近端外翻截骨校正跖骨内翻畸形。结果 :随访 6个月～ 3年半 ,优 9例 16足 ,良 3例 4足 ,差 1例 1足 ,优良 95 .2 % ,无跖骨头坏死和截骨处不愈合。术前外翻角平均 3 5° ,术后为 11° ,第一跖骨间角术前平均 19° ,术后为 5 .8° ,近端关节固定角术前平均18° ,术后为 2°。结论 :外翻矫形应根据畸形情况及其病理改变选择手术方式。本手术方式矫形满意 ,但需严格掌握其手术适应证。

Objective:To explore an effective method of treatment for hallux valgus.Methods:Based on the traditional treatment regimen for hallux valgus,Reverdin operation combined with osteotomy of proximal first metatarsal were performed from Oct 1997 to Sep. 2000 in 21 feet of 13 paients.The proximal articular set angle(PASA)was corrected using Reverdin operation with a medially based,closing wedge osteotomy of the first metatarsal head and the first intermetatarsal angle was corrected by osteotomy of proximal first metatarsal Results:The rate of excellent and good results was 95.2% with a follow-up from 6 months to 3 years and 6 months and there was no complication of delayed or avascular necrosis of the metatarsal after operation.X-ray showed the hallux valgus angle was reduced from averaged 35 degrees to 11 degreed,PASA from averaged 18 degrees to 2 degrees,the first intermetatarsal angle from 19 degrees to 5.3 degrees.Conclusion:The deformity and pathological changes are more important factors for selecting operative procedure for the treatment of hallux valgus.This method is an ideal operation of treatment for hallux valgus.