小切口去骨赘及跖骨截骨结合拇伸肌腱延长矫正重度拇外翻的疗效评价

Therapeutic evaluation of osteophyte removal through small incision,metatarsal osteotomy combined with prolongation of extensor pollicis tendon in the correction of severe hallux valgus

目的探讨小切口去骨赘、跖骨截骨结合拇伸肌腱延长术治疗重度拇外翻的临床疗效。方法对37例(65足)重度拇外翻患者采用小切口在第一二跖骨头间切断拇收肌,松解挛缩跖趾关节外侧关节囊,微型磨钻去除第一跖骨头增生骨赘,微型摆锯斜形截骨,延长拇伸肌腱;结合手法矫正拇外翻角、跖骨间夹角、下移跖骨头,并以"8"字包扎法外固定。手术前后分别拍照,采用美国足踝矫形学会拇外翻评分标准进行疗效评分。结果共矫正37例(65足),术后随访1年,拇外翻外形矫正及恢复足趾正常功能显著,单足优良率达93.85%,患者术后满意率为86.49%。结论采用小切口去骨赘、跖骨截骨结合拇伸肌腱延长术治疗重度拇外翻畸形,能较好地矫正前足异常,效果可靠,患者的满意率较高,临床可推广应用。

Objective To explore the clinical efficacy of osteophyte removal through small incision,metatarsal osteotomy combined with prolongation of extensor pollicis tendon in the treatment of severe hallux valgus.Methods The adductor pollicis muscle was transected between the first and second metatarsal through a small incision in 37 patients(65 feet)with severe hallux valgus.The lateral joint capsule of contracture metatarsophalangeal joint was released,hyperplasia osteophyte was removed from the first metatarsal head by mini-drill,oblique osteotomy by micro-swing saw and extensor pollicis tendon was prolonged.The hallux valgus angle,intermetatarsal angle and metatarsal head drop down were corrected by manual manipulation and"8"-shaped wrap method was performed for external fixation.The photographs were taken before and after operation and the efficacy was evaluated by the American Ankle Orthopaedic Association Hallux Valgus scoring standard.Results A total of 37 patients(65 feet)were corrected and followed up 1 year.The hallux valgus was corrected,and the normal function of the toe was restored obviously.The excellent and good rate of single foot was 93.85%.After operation,patients’satisfaction rate was 86.49%.Conclusion The application of osteophyte removal through small incision,metatarsal osteotomy combined with prolongation of extensor pollicis tendon in the treatment of severe hallux valgus deformity could correct abnormal forefoot.The efficacy was reliable.It should be considered for popularization and application in clinic.