摘要
目的探讨医原性躅内翻矫形手术治疗的经验与防治方法。方法1989年7月至2005年5月治疗医原性躅内翻27例（28足），男4例（4足），女23例（24足）；年龄24～62岁，平均51.3岁。采用Hiss手术13例（14足）、myerson手术10例（10足）、跖骨远端截骨术4例（4足）。术前对每个病例进行临床、x线片与CT检查，分析其躅内翻的发病原因。术后对所有病例进行随访，按美国足踝外科协会maryland百分制评分系统，对疼痛、功能、体征进行评分。结果27例（28足）获得随访，随访时间1年～17年2个月，平均5．7年。术前评分平均为52．4（41～57）分，术后平均为89（64～100）分。疗效优13足（46_4％），良11足（39．3％），可4足（14-3％），优良率85．7％。施行Hiss手术者中1例术后13年发生蹿长伸肌腱轻度挛缩，采用myerson手术者术后背伸较术前平均减少9.5°（8°。～12．5°。）。医原性躅内翻的发生原因有5个，其中最常见的是在躅外翻矫形时跖骨头内侧骨赘切除过多，本组有14足（50％），然后依次为内侧关节囊过度重叠紧缩缝合5足（17．9％），矫形时过度纠正IMA4足（14-4％），术后长时期固定3足（10．8％），术后躅趾外展与内收肌力失衡2足（6．9％）。结论躅外翻矫形并发躅内翻最常见的原因是对跖骨头内侧骨赘切除过多。术者在治疗医原性躅内翻时，应根据各个病例的不同情况选择不同的术式进行治疗。采用Hiss、Myerson软组织重建术与Chevron跖骨远端截骨术矫正医原性跨内翻切实可行、疗效可靠。
To discuss the treatment experiences and preventive methods of the orthope- dic operation for the iatrogenic hallux varus. Methods From July 1989 to May 2005, 27 cases （28 feet） of iatrogenic hallux varus were treated, including 4 males （4 feet）, 23 females （24 feet）; the age of them ranged from 24 to 62 years old （the average age was 51.3 years old）. Three surgical methods were performed, including Hiss operation in 13 cases （14 feet）, Myerson operation in 10 cases （10 feet）, far-end metatarsal osteotomy in 4 cases （4 feet）. The Maryland centesimal point system of American Orthopedic Foot ＆ Ankle Society （AOFAS） was used to evaluate the pain, function and sign. Results 27 cases were followed up 5.7 years. The Maryland score was 52.4（41 to 57） preoperatively, 89 （64 to 97） postoperatively. The therapeutic effects of the cases are： 13 feet were excellent （46.4%）; 11 feet were good （39.3%）, and 4 feet were fair （14.3%）, the excellent and good rate was 85.7%. Among the cases treated with Hiss operation, one case sufferred light contraction of the musculus extensor pollicis longus tendon; and the average decrease of the back extension was 9.5°（8°.to 12.5°.）. There were five causes to result in the iatrogenic hallux varus. The most common cause was the over-cut of the spur in the medial side of the metatarsal head during the operation, including 14 feet （50%） in the group; then 5 feet （17.9%） caused by the medial joint capsule excessive overlapped and contracted suture, 4 feet （14.4%） caused by the over-correction of the IMA during the orthopedic treatment, 3 feet （10.8%） caused by the long time fixation after operation, 2 feet （6.9%） caused by the myo- dynamia imbalance of the abductors and adductors of the hallux. Conclusion The most common cause of iatrogenic hallux varus is the over-cut of the spur in the medial side of the metatarsal head. The surgical methods should depend on the different conditions of the cases. It is reliably f
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第11期832-837,共6页
Chinese Journal of Orthopaedics
关键词
躅趾
畸形
医原性疾病
Hallux
Abnormalities
Iatrogenic disease
