Scarf联合Akin截骨术治疗中、重度踇外翻的临床疗效

Scarf combined with Akin osteotomies for moderate and severe hallux valgus

目的评价Scarf联合Akin截骨术治疗中、重度踇外翻畸形的临床疗效。方法选取2012年4月-2016年4月郑州大学附属郑州市中心医院采用Scarf联合Akin截骨术治疗中、重度踇外翻畸形患者60例(98足)。术前术后均行患足X射线检查,观察疗效及影像学改变,同时采用美国足踝外科学会足功能评分系统(AOFAS)评价治疗效果。结果60例患者均获得随访,随访时间6~20个月,术后2例(2足)患者出现趾背内侧皮肤麻木,考虑为神经损伤,2~4个月后好转,手术切口均一期愈合,截骨处无延迟愈合或不愈合,愈合时间14周。术后踇外翻角度(11.1±3.2)°、第1、2跖骨间角(7.1±2.6)°和胫侧籽骨位置(2.13±0.50)级均低于术前[(39.8±6.2)°、(18.2±4.6)°和(4.79±0.53)级],AOFAS评分[(86.2±8.2)分]高于术前[(36.8±9.2)分](P<0.05)。结论Scarf联合Akin截骨术治疗中重度踇外翻畸形临床疗效良好,并发症少,复发率低。

Objective To study the clinical efficacy of Scarf combined with Akin osteotomies for moderate and severe hallux valgus.Methods Sixty(98 feet)patients received Scarf combined with Akin osteotomies were selected.Before and after the operation,all patients were examined with X-ray film,and the curative effect and imaging changes were observed.At the same time,the AOFAS score(American Orthopaedic Foot and Ankle Society foot function score system)was used to evaluate the therapeutic effect.Results All operations were followed up for 6 to 20 months.In 2 cases(2 feet)after operation,the back medial skin of the great toe was numb,which was considered as a nerve injury and improved after 2 to 4 months.Operative incision of 60 cases were primary healing.The average healing time was 14 weeks at osteotomy part,with no delayed union or nonunion.After surgery,hallux valgus angle(11.1±3.2)°,the 1 to 2 intermetataral angle(7.1±2.6)°and tibial sesamoid position(2.13±0.50)were significantly lower than the preoperative level respectively[(39.8±6.2)°,(18.2±4.6)°and(4.79±0.53)°,P<0.05].AOFAS score(86.2±8.2)was significantly higher after surgery than that before surgery[(36.8±9.2)°,P<0.05)].Conclusion Scarf combined with Akin osteotomies can get good clinical curative effect for moderate and severe hallux valgus with less complications and low recurrence rate.