Scarf截骨联合Akin截骨治疗拇外翻

Scarf osteotomy combined with Akin osteotomy for treatment of hallux valgus

目的探讨Scarf截骨联合Akin截骨治疗拇外翻的临床疗效。方法采用第1跖骨Scarf截骨联合Akin截骨治疗20例拇外翻患者(22足)。观察患者术后并发症情况及截骨愈合时间。比较术前、术后3 d及末次随访时拇外翻角(HVA)及第1、2跖骨间夹角(IMA)变化;比较术前及末次随访时AOFAS评分。结果患者均获得随访,时间8~30(17.4±6.7)个月。患者均无深静脉栓塞、拇内翻发生;截骨全部愈合,愈合时间为3~4(3.42±0.51)个月。1足切口感染,换药3周治愈;1足转移性跖骨痛,行矫形足垫治疗后好转;1足拇趾感觉减退,经口服营养神经药物,4个月后好转。HVA及IMA术后3 d、末次随访时与术前比较差异均有统计学意义(P<0.01)。末次随访时AOFAS评分77~87(81.3±3.6)分,较术前40~52(44.2±4.5)分明显提高(P<0.01)。结论采用Scarf截骨联合Akin治疗拇外翻手术方式可靠,严格把握手术适应证,可以获得满意的临床疗效。

Objective To investigate the clinical efficiency of Scarf osteotomy combined with Akin osteotomy for treatment of hallux valgus.Methods The 20 patients(22 feet)with hallux valgus were treated by Scarf osteotomy of the first metatarsus combined with Akin osteotomy.Postoperative complications and the healing time of osteotomies were observed.The hallux valgus angle(HVA)and first-second intermetatarsal angle(IMA)were compared among the preoperation,3 d postoperation,and the final follow-up.At the final follow-up,the AOFAS scores were compared with the preoperative ones.Results All the patients were followed up for 8~30(17.4±6.7)months.All the patients had no deep venous thrombosis and hallux varus.All the osteotomies were healed,the healing time of osteotomies was 3~4(3.42±0.51)months.Wound infection occurred in 1 foot,which got delayed healing by dressing change for 3 weeks;1 foot had metastatic metatarsalgia,and the pain relieved after Custom-Made orthotics.Hypesthesia of the toe occurred in 1 foot,and improved by oral trophic nerve drugs treatment for 4 months.The HVA and IMA at postoperative 3 d and last follow-up had no statistical differences,compared with those of the preoperation(P<0.01).At final follow-up,the AOFAS scores of 77~87(81.3±3.6)points were significantly increased than 40~52(44.2±4.5)points of the preoperation(P<0.01).Conclusions As long as the indication for the combined procedures is strictly applied,Scarf osteotomy combined with Akin osteotomy for hallux valgus can achieve satisfied outcomes.