CAJ | 학술논문

目的探讨第一跖骨双截骨矫正重度(足母)外翻畸形的手术疗效.方法回顾性分析2008年1月至2011年12月,采用第一跖骨双截骨术治疗并获得随访的62例(87足)第一跖骨远端关节面角(distal metatarsal articular angle,DMAA)增大的重度(足母)外翻患者资料,男9例(14足),女53例(73足)；年龄28～70岁,平均56岁.术前X线片示(足母)外翻角(hallux valgus angle,HVA)平均为48.6°,第一、二跖骨间角(intermetatarsal angle,IMA)平均为19.8°,DMAA平均为22.1°.术前根据患者畸形情况制定手术方案,截骨部位、角度、截骨量均依据术前测量值操作.比较术前、术后及取内固定前HVA、IMA、DMAA的变化,同时采用美国足踝外科协会(AOFAS)(足母)趾-跖趾-趾间关节功能评分标准评价疗效.结果 62例(87足)获得随访,随访时间为10～57个月,平均21个月.术后6个月,HVA 14.6°±1.2°,IMA 7.9°±0.7°,DMAA 7.7°±0.9°,矫形效果均满意.术后出现(足母)僵硬2例,皮神经损伤2例,转移性跖痛1例,无一例发生畸形明显复发、骨不愈合及跖骨坏死.术后AOFAS评分由术前平均(28.4±9.1)分达到术后1年的(91.8±1.8)分；49足为优,31足为良,7足为可,优良率为92.0％(80/87).结论第一跖骨双截骨术可有效矫正DMAA增大的重度(足母)外翻畸形,患者术后可早期部分负重,并发症少,手术疗效佳.
목적 탐토제일척골쌍절골교정중도(족모)외번기형적수술료효.방법 회고성분석2008년1월지2011년12월,채용제일척골쌍절골술치료병획득수방적62례(87족)제일척골원단관절면각(distal metatarsal articular angle,DMAA)증대적중도(족모)외번환자자료,남9례(14족),녀53례(73족)；년령28～70세,평균56세.술전X선편시(족모)외번각(hallux valgus angle,HVA)평균위48.6°,제일、이척골간각(intermetatarsal angle,IMA)평균위19.8°,DMAA평균위22.1°.술전근거환자기형정황제정수술방안,절골부위、각도、절골량균의거술전측량치조작.비교술전、술후급취내고정전HVA、IMA、DMAA적변화,동시채용미국족과외과협회(AOFAS)(족모)지-척지-지간관절공능평분표준평개료효.결과 62례(87족)획득수방,수방시간위10～57개월,평균21개월.술후6개월,HVA 14.6°±1.2°,IMA 7.9°±0.7°,DMAA 7.7°±0.9°,교형효과균만의.술후출현(족모)강경2례,피신경손상2례,전이성척통1례,무일례발생기형명현복발、골불유합급척골배사.술후AOFAS평분유술전평균(28.4±9.1)분체도술후1년적(91.8±1.8)분；49족위우,31족위량,7족위가,우량솔위92.0％(80/87).결론 제일척골쌍절골술가유효교정DMAA증대적중도(족모)외번기형,환자술후가조기부분부중,병발증소,수술료효가.
Objective To explore the curative effect of the operation of double wedge osteotomy of the first metatarsal for correction of severe hallux valgus.Methods The data of 62 patients (87 feet) with severe hallux valgus caused by enlarged distal metatarsal articular angle (DMAA) who were followed up after receiving the treatment of double wedge osteotomy of the first metatarsal from January 2008 to December 2011 were analyzed retrospectively.There are 9 males (14 feet),and 53 females (73 feet),with an average age of 56 years (range,28-70 years).Preoperative radiographs showed hallux valgus angle (HVA) was 48.6° in average,intermetatarsal angle (IMA) was 19.8° in average,and DMAA was 22.1° in avcragc.Thc opcration plan was made based on the preoperative deformity,and the osteotomy site,the angle,the capacity of osteotomy was all based on preoperative measurement.Compare the changes of HVA,IMA,DMAA before and after operation.The changes were also compared before and after the internal fixation extraction.The curative effect was observation based on American Orthopaedic Foot and Ankle Society (AOFAS) propodium score standard.Results Sixty-two patients (87 feet) were followed up for 10 to 57 months,with an average of 21 months.HVA (14.6°±1.2°),IMA (7.9°±0.7°),DMAA (7.7°±0.9°) were all satisfied 6 months after the operation.Stiff occurred in 2 patients after the operation.Cutaneous nerve injury occurred in 2 patients,and metastatic metatarsalgia occurred in 1 patient.No sever recurrence of deformity,bone nonunion and bone necrosis was found in all the patients.AOFAS score reached 91.8±1.8 one year after the operation,which was 28.4±9.1 preoperatively.Among them,49 feet were rated as excellent,31 as good,and 7 as fair.The excellent and good rate was 92％ (80/87).Conclusion The first metatarsal double osteotomy can effectively correct the severe hallux valgus deformity with enlarged DMAA with few complications.It achieves good effect.Patients can bear part of the loading in the early stage of recovery after operation.