CAJ | 학술논문

目的探讨(足母)外翻术后再手术的原因及临床处理对策.方法回顾性分析2005年12月至2011年12月(足母)外翻术后冉手术的23例患者完整资料,男3例,女20例；年龄28～85岁,平均63.1岁.再手术时间为初次手术后6-96个月,平均27.6个月.分析23例患者(足母)外翻术后再手术原因,根据患者临床症状、体征及X线片所示选择再手术方式.结果 23例(足母)外翻患者术后再手术原因包括:复发5例,(足母)内翻2例,转移性跖痛5例,内固定松动7例,内固定断裂4例.再手术方式包括:跖楔关节融合(3例),基底截骨再次行Akin截骨(1例),基底截骨加跖趾关节融合(1例),跖趾关节融合(2例),改良Weil截骨(5例),去除内固定(11例).术后随访时间6～36个月,平均16.5个月.美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)(足母)趾、跖趾、趾间关节评分从初次术后(65.3±7.5)分改善到再次术后(89.2±8.9)分；术后患者主观满意度评价,优17例,良4例,可2例,优良率91.3％(21/23).结论 (足母)外翻术后再手术原因较多,包括复发、(足母)内翻、转移性跖痛、内固定松动、断裂等.冉手术时需仔细分析患者临床症状、体征及X线检查结果选择个性化方案进行治疗.
목적 탐토(족모)외번술후재수술적원인급림상처리대책.방법 회고성분석2005년12월지2011년12월(족모)외번술후염수술적23례환자완정자료,남3례,녀20례；년령28～85세,평균63.1세.재수술시간위초차수술후6-96개월,평균27.6개월.분석23례환자(족모)외번술후재수술원인,근거환자림상증상、체정급X선편소시선택재수술방식.결과 23례(족모)외번환자술후재수술원인포괄:복발5례,(족모)내번2례,전이성척통5례,내고정송동7례,내고정단렬4례.재수술방식포괄:척설관절융합(3례),기저절골재차행Akin절골(1례),기저절골가척지관절융합(1례),척지관절융합(2례),개량Weil절골(5례),거제내고정(11례).술후수방시간6～36개월,평균16.5개월.미국족과외과협회(American Orthopaedic Foot and Ankle Society,AOFAS)(족모)지、척지、지간관절평분종초차술후(65.3±7.5)분개선도재차술후(89.2±8.9)분；술후환자주관만의도평개,우17례,량4례,가2례,우량솔91.3％(21/23).결론 (족모)외번술후재수술원인교다,포괄복발、(족모)내번、전이성척통、내고정송동、단렬등.염수술시수자세분석환자림상증상、체정급X선검사결과선택개성화방안진행치료.
Objective To explore the causes of failed Hallux valgus surgery and its corresponding salvage interventions.Methods The data of 23 patients (3 males,20 females) who received hallux valgus revision surgeries,from December 2005 to December 2011 was retrospectively analyzed.Their average age was 63.1 years (range,28-85 years).The mean follow-up duration of the first operation was 27.6 months (range,6-96 months).The reasons for the failed operations were firstly analyzed and appropriate revision procedures were then chosen based on their clinical manifestation,physical examination and X-ray findings.Results The causes of the 23 primarily failed hallux valgus patients included 5 recurrent hallux valgus deformity,2 hallux varus,5 metatarsalgia,7 internal fixations looseness and 4 internal fixations breakdown.The salvage surgical procedures consisted of 3 first tarsometatarsal joint fusions,1 of first netatarsal basal osteotomy and Akin osteotomy again after 2 years,2 of metatarsophalangeal joint arthrodeses and 5 Weil osteotomies,11 removals of internal fixation.The remainder 1 patient had combined first tarsometatarsal joint fusions and metatarsophalangeal joint arthrodesis.The mean followup duration was 16.5 months (range,6-36months).The postoperative average American Orthopaedic Foot and Ankle Society (AOFAS) metatarsophalangeal-interphalangeal scale was 89.2±8.9,which was 65.3±7.5 before revision surgeries.Excellence rate was 91.3％ (21/23),with 17 cases whose effect were excellent,4 good and 2 fair.Conclusion The reasons of failed hallux valgus surgery varied a lot due to the diversities of surgical methods including relapse,varus,metatarsalgia,internal fixation,break and so on.Fully understand of the pathogenesis as well as clinical presentations were critical for surgeons.Appropriate candidate,proper internal fixation material and suitable surgical methods were other assurances for successful hallux valgus treatments.The decision of revision procedure should be individualized and take clinical manifestation,physical examination as well as radiographic findings into account.