改良Ludloff截骨联合Reverdin截骨治疗中重度外翻

Efficacy of modified Ludloff combined with Reverdin Osteotomies on moderate and several hallux valgus

目的探讨改良Ludloff截骨联合Reverdin截骨治疗合并第一跖骨远端关节面角(distal metatarsal articular angle,DMAA)增大的中重度外翻的疗效分析。方法回顾性分析自2015年2月至2017年2月我科治疗的DMAA增大的中重度外翻病人32例(40足)。其中,男4例(5足),女28例(35足);年龄为29~78岁,平均52.4岁。术前行足部负重位X线检查:外翻角(hallux valgus angle,HVA)为30°~55°,平均42.4°±3.30°;第一、二跖骨间夹角(intermetatarsal angle,IMA)为13°~24°,平均17.7°±1.9°;DMAA为17°~39°,平均22.6°±1.1°。行患足美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)评分标准评分为41~87分,平均(68.3±2.9)分。均采用改良Ludloff截骨联合Reverdin截骨。对比手术前后HVA、IMA及DMAA,参照AOFAS评分标准进行手术疗效分析。结果 32例病人术后获得6~18个月随访。所有病人无感染、骨折不愈合、跖骨头坏死及畸形复发等并发症的发生,有1足切口延迟愈合。术后6个月行X线检查,HVA为13.2°±3.1°、IMA为8.1°±1.7°、DMAA为7.6°±1.2°,以上指标较术前减小,差异均有统计学意义(均P<0.05)。术后6个月AOFAS评分:优29足,良8足,可3足,优良率为92.5%。AOFAS评分为(77.0±3.0)分较术前升高,差异具有统计学意义(t=41.18,P=0.004);结论改良Ludloff截骨联合Reverdin截骨治疗合并DMAA增大的中重度外翻可以很好的纠正畸形。

Objective To discuss the efficacy of modified Ludloff combined with Reverdin osteotomies on moderate and several hallux valgus with increase of distal metatarsal articular angle(DMAA).Methods The clinical data of 32 cases(40 feet)of moderate and several hallux valgus treated in Department of Foot and Ankle surgery of our hospital from January 2015 to January 2017 were retrospectively analyzed.All the patients with increased DMAA were given modified Ludloff combined with Reverdin osteotomies.The Hallux valgus angle(HVA),1-2 intermetatarsal angle(IMA)and distal metatarsal articular angle(DMAA)were compared before and after operation.The efficacy was evaluated in accordance with the American Orthopaedic Foot&Ankle Association(AOFAS)Ankle-Hindfoot Scale.Results All of the 32 cases were followed up after operation for 6 to 18 months.All the patients recovered well without postoperative complications such as infection,fracture nonunion,osteonecrosis of the first metatarsal head and recurrence of deformity,except one foot with slow recovery of the incision.All of the patients were checked by X-ray examination and HVA,IMA and DMAA were measured 6 months postoperatively.HVA was 13.2°±3.1°,IMA was 8.1°±1.7°,and DMAA was 7.6°±1.2°.All the angles mentioned above decreased(all P<0.05).The marks given by AOFAS at 6th month after operation(77.0±3.0)were significantly increased as compared with those before operation(68.3±2.9)(t=41.18,P=0.004).According to the marks,the efficacy was excellent in 29 feet,good in 8 feet and fair in 3 feet,with the excellent and good rate being 92.5%.Conclusion For moderate and severe hallux valgus with increased DMAA,the treatment of modified Ludloff combined with Reverdin Osteotomies can effectively correct the deformity and achieve a good therapeutic effect.