改良Mitchell手术治疗外翻的疗效分析

Result of modified Mitchell operation for treatment of hallux valgus

目的：观察改良Mitchell手术治疗Mu外翻的疗效。方法：自1998年3月－2001年10月对20你（39足）Mu外翻患者改良Mitchell手术。术前摄负重位X线片，测量HVA平均为29．5°，IMA平均为12．5°，本术式与传统Mitchell手术不同的是在第一跖骨远端只行一次横行截骨，不留外侧棘，根据IMA的大小决定截骨远上移的多少，再向跖侧移位2－3mm，用可吸收螺钉固定，结果：随访38足，随访时间为11－38个月，平均个月，优32足，良5足，差1足，率为97．4％，术后负重位X线片测量，HVA平均为14．5°，平均改善15°；IMA平均为8．5°，平均改善4°。结论：改良Mitchell手术可矫正第一跖骨内翻，更重要的在于矫正畸形而不破坏Mu趾的生物力学作用，第一跖骨头的跖侧移位，重建了足横弓，恢复了Mu跖的负重功能。

Objective To evaluated the result of modified Mitchell operation for treatment of hallux valgus. Methods From March 1998 to October 2001, 39 feet of 20 patients were treated with modified Mitchell procedure. Before operation, HVA averaged 29.5° and IMA averaged 12.5° were measured on standing AP radiographs. The lateral displacement of the capital fragment was depended on the amount of IMA and the capital fragment shifted plantarly 2-3 mm. Fixation was achieved with an absorbable screw. The lateral spike on the distal fragment was not preserved in this operation. Results After follow-up of 11-38 months, patients rated as excellent or good in 97.4%. The average postoperative HVA was 14.5° and IMA was 8.5°, the average HAV correction was 15° and 4° for the IMA. Conclusion The modified Mitchell procedure provides satisfactory deformity correction. The transverse arch of metatarsals is reconstructed since distal part of the first metatarsal is shifted plantarly in this operation.