CAJ | 학술논문

目的探讨第1跖骨基底截骨结合Chevron-Gerbert手术治疗严重(足母)外翻畸形的临床疗效.方法 2004年6月至2008年8月利用第1跖骨基底截骨结合Chevron-Gerbert手术治疗重度(足母)外翻患者37例(66足),男性5例(10足),女性21例(38足);年龄21～76岁,平均58岁.术前、术后、随访时均拍摄足部负重位正、侧位X线片,测量(足母)外翻角、第1、2跖骨间角、近侧关节固定角.比较术前、术后6周、末次随访时(足母)外翻相关各角度的X线测量值,并结合美国足踝外科协会(AOFAS)的Maryland评分法观察疗效.结果本组患者26例(48足)得到随访,随访时间1～4年,平均2.3年.末次随访时(足母)外翻角较术前纠正25.6°±3.8°,第1、2跖骨间角较术前纠正8.6°±2.4°,近侧关节固定角较术前纠正4.7°±4.2°.根据AOFAS百分评分法评定,优15例(28足)、良8例(16足)、可3例(4足),优良率为91.7%.结论利用第1跖骨基底截骨结合Chevron-Gerbert手术治疗严重(足母)外翻畸形的临床疗效良好,但有手术相对复杂、需行多段截骨及内固定等缺点.
목적 탐토제1척골기저절골결합Chevron-Gerbert수술치료엄중(족모)외번기형적림상료효.방법 2004년6월지2008년8월이용제1척골기저절골결합Chevron-Gerbert수술치료중도(족모)외번환자37례(66족),남성5례(10족),녀성21례(38족);년령21～76세,평균58세.술전、술후、수방시균박섭족부부중위정、측위X선편,측량(족모)외번각、제1、2척골간각、근측관절고정각.비교술전、술후6주、말차수방시(족모)외번상관각각도적X선측량치,병결합미국족과외과협회(AOFAS)적Maryland평분법관찰료효.결과 본조환자26례(48족)득도수방,수방시간1～4년,평균2.3년.말차수방시(족모)외번각교술전규정25.6°±3.8°,제1、2척골간각교술전규정8.6°±2.4°,근측관절고정각교술전규정4.7°±4.2°.근거AOFAS백분평분법평정,우15례(28족)、량8례(16족)、가3례(4족),우량솔위91.7%.결론 이용제1척골기저절골결합Chevron-Gerbert수술치료엄중(족모)외번기형적림상료효량호,단유수술상대복잡、수행다단절골급내고정등결점.
Objective To evaluate the clinical efficacy of treatment on the cases of severe hallux valgus by the first metatarsal basal osteotomy combined with Chevron-Gerbert operation. Methods From June 2004 to August 2008, 37 cases of severe hallux valgus (66 feet) underwent first metatarsal basal osteotomy combined with Chevron-Gerbert operation. There were 5 males (10 feet ) and 21 females (38 feet), aged 21-76 years (mean 58 years). For all patients with follow-up, radiographic measurements of frontal and lateral position of foot were taken to measure the hallux valgus angle ( HVA), the IMA (intermetatarsal angle) and the proximal articular set angle (PASA) preoperatively, postoperatively and in follow-up respectively. The measuring results were compared among the preoperative, the 6-week postoperative and the final follow-up. At the same time the patients were evaluated with the AOFAS Maryland score. Results Of the original 37 patients, 26 patients (48 feet) were followed up. The mean durations of follow-up was 2. 3 years (range from I to 4 years). At final follow-up, HVA corrected 25.6°±3.8°, IMA corrected 8.6°± 2.4°, and PASA corrected 4. 7°± 4. 2°. According to AOFAS rating system, 91.7% patients were rated as excellent or good with excellent in 15 patients (28 feet), good in 8 patients ( 16 feet), and fair in 3 patients (4 feet). Conclusions First metatarsal basal osteotomy combined with Chevron-Gerbert operation has good efficacy to the patients with severe hallux valgus. However there are disadvantages such as complexity relatively for multi-stage osteotomy and internal fixation.