摘要
目的探讨Scarf截骨治疗拇外翻的手术适应证、手术方法及近期疗效。方法2001年1月至2005年12月，手术治疗拇外翻患者25例40足，其中23例36足获得随访，男2例2足，女21例34足；年龄28～70岁，平均56岁。手术均采用Scarf截骨，术中2枚螺钉固定。比较手术前、后及末次随访时与拇外翻相关的各角度的X线测量值，并结合AOFAS和VAS评分观察疗效。术前、术后的各组数据采用SPSS 11．5统计软件进行统计学分析。结果拇外翻角和第一、二跖骨间角从术前的38．0°±22．0°和16．0°±4．6°改善到术后的14．0°±6．1°和7．8°±2．9°，第一跖骨远端关节面角从23．0°±15．0°矫正为7．7°±5．1°。末次随访时拇外翻角为15．0°±5．7°，第一、二跖骨间角为8．8°±4．1°，第一跖骨远端关节面角为5．9°±3.8°。患者随访10-57个月，平均32个月。AOFAS评分从术前（46±17）分改善为（85±11）分，VAS评分从（7．4±2．3）分改善为（3.3±1．9）分。术后拇僵硬2例，最内侧皮神经损伤1例，转移性跖骨痛1例。结论Scarf截骨具有较好的自身稳定性，并发症少，手术效果好，可作为中、重度拇外翻矫形手术的首选方法。
Objective To retrospectively study and discuss the indications, surgical techniques and outcomes of Scarf osteotomy in the treatment of hallux valgus. Methods From January 2001 to December 2005, 25 patients （40 feet） with hallux valgus received Scarf surgery in our hospital, which included 2 males （2 feet） and 21 females（34 feet）, with the mean age of 56 years （range, 28-70 years）. The Scarf osteotomy was performed to correct the deformities and two screws were used to fix the split bone. Among all patients, 23 cases （36 feet） were followed up for 10 to 57 months, with the mean 32 months. The preoperative, postoperative and final follow-up X-ray films of all patients were collected. The hallux valgus angle, intermetatarsal angle and distal metatarsal articular angle were measured and analyzed. The surgical outcome was evaluated combined with the AOFAS score and VAS score. All parameters were statistically analyzed with software SPSS 11.5. Results The main postoperative complaint was local swelling, which usually subsided within 1- 3 months. The formation of callus was observed in most patients after 12 weeks. The average hallux valgus angle decreased from 38.0°±22.0° preoperatively to 14.0°±6.1° postoperatively, the average intermetatarsal angle did from 16.0°±4.6° to 7.8°±2.9°, and the average distal metatarsal articular angle did from 23.0°± 15.0° to 7.7°±5.1° respectively. At the time of final follow-up, the average hallux valgus angle was 15.0°± 5.7°, the intermetatarsal angle was 8.8°±4.1°, and the distal metatarsal articular angle was 5.9°±3.8°. The loss of correction in hallux valgus angle, intermetatarsal angle and tibial sesamoid displacement was insignificant, and a decrease inclination of the distal metatarsal articular angle was even observed. AOFAS score was 46±17 before surgery and improved to 85±11 at the final follow-up, the VAS score improved from 7.4±2.3 to 3.3±1.9 respectively. Both the evaluation systems showed good results after the surgery. The complications included hallux rigidus in 2 cases, injury of most medial cutaneous nerve in 1 case and transfer metatarsalgia in 1 case. Conclusion The outcome of this surgical technique is good. It is stable and the complication rate is low. The Scarf osteotomy provides a predictable and effective correction to moderate and severe hallux valgus deformities.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第6期405-408,共4页
Chinese Journal of Orthopaedics
关键词
拇外翻
跖骨
截骨术
Hallux valgus
Metatarsal bone
Osteotomy
