Scarf截骨术治疗中、重度拇外翻畸形的疗效

Efficacy of Scarf osteotomy for treatment of moderate-severe hallux valgus deformity

目的探讨Scarf截骨术治疗中、重度拇外翻畸形的临床疗效。方法应用Scarf截骨术治疗29例拇外翻畸形患者。记录术后并发症的发生情况。比较手术前后AOFAS踝-后足评分、行走时疼痛VAS评分、拇外翻角(HVA)以及第1、2跖骨间角(IMA)。结果患者均获得随访,时间12~48(26.2±9.7)个月。患足切口均一期愈合,拇外翻外观矫正满意,截骨处骨性愈合时间6~16(10.4±5.7)周。术后1例出现拇趾跖内侧皮肤麻木,术后2个月症状逐渐消失;2例术后残留转移性跖骨痛,但患者均能接受目前治疗状态。术后并发症发生率3/29,无畸形复发、趾坏死等严重并发症发生。末次随访时,AOFAS踝-后足评分由术前34~76(61.5±18.2)分上升到58~100(90.3±37.9)分;行走时疼痛VAS评分由术前4~8(6.7±5.9)分降低到0~4(1.9±0.9)分;HVA由术前20°~50°(34.6°±29.0°)降低到5°~30°(14.9°±8.4°);IMA由术前10°~25°(15.8°±11.7°)降低到0°~15°(7.2°±1.8°);以上各项指标均较术前明显改善(P<0.05)。结论Scarf截骨术治疗中、重度拇外翻畸形可获得满意的临床疗效。

Objective To investigate the clinical efficacy of Scarf osteotomy in the treatment of moderate-severe hallux valgus deformity.Methods The 29 patients with hallux valgus were treated with Scarf osteotomy.The incidence situation of postoperative complications was recorded.AOFAS ankle-hindfoot score,pain VAS during walking,hallux valgus angle(HVA)and the first-second intermetatarsal angle(IMA)were compared before and after operation.Results All patients were followed up for 12~48(26.2±9.7)months.All incisions healed in one-stage,and the appearance of hallux valgus was corrected well,and the bony healing of osteotomy site was obtained within 6~16(10.4±5.7)weeks.One patient developed numbness of the medial plantar skin of the big toe,and the symptoms gradually disappeared at 2 months postoperation;two patients had residual metastatic metatarsalgia postoperatively,but all patients could accept the current treatment status,the incidence rate of postoperative complications was 3/29.There were no serious complications such as deformity recurrence and toes necrosis.At the last follow-up,the AOFAS ankle-hindfoot score was increased from preoperative 34~76(61.5±18.2)points to 58~100(90.3±37.9)points;the pain VAS during walking was decreased from preoperative 4~8(6.7±5.9)points to 0~4(1.9±0.9)points;the HVA was decreased from preoperative 20°~50°(34.6°±29.0°)to 5°~30°(14.9°±8.4°);the first-second IMA were decreased from 10°~25°(15.8°±11.7°)preoperatively to 0°~15°(7.2°±1.8°);and the above various indexes were significantly improved than the preoperation(P<0.05).Conclusions Scarf osteotomy can obtain satisfactory clinical effect in the treatment of moderate-severe hallux valgus.