經(jīng)內(nèi)側(cè)切口行外側(cè)軟組織松解聯(lián)合Austin、Akin截骨術(shù)治療中度外翻

張圣兵，張洪濤，鈕俊杰，李俊坤，王根林，楊惠林

(1.江蘇省無錫市第二中醫(yī)醫(yī)院骨科，江蘇 無錫　214121；2.蘇州大學(xué)附屬第一醫(yī)院骨科，江蘇 蘇州　215006)

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張圣兵1，張洪濤2*，鈕俊杰2，李俊坤2，王根林2，楊惠林2

(1.江蘇省無錫市第二中醫(yī)醫(yī)院骨科，江蘇 無錫214121；2.蘇州大學(xué)附屬第一醫(yī)院骨科，江蘇 蘇州215006)

1　資料與方法

2　結(jié)　　果

表1　患者術(shù)前、術(shù)后的HVA、IMA、AOFAS前足評(píng)分結(jié)果比較

表2　患者術(shù)前、末次隨訪的HVA、IMA、　AOFAS前足評(píng)分結(jié)果比較

3　討　　論

圖1術(shù)前大體照示術(shù)前左足外翻畸形圖2術(shù)中大體照示經(jīng)內(nèi)側(cè)切口通過關(guān)節(jié)間隙行外側(cè)軟組織松解圖3術(shù)后大體照示左足畸形已矯正

圖4術(shù)前X線片示左足HVA、IMA明顯增大圖5術(shù)后X線片示左足HVA、IMA已恢復(fù)正常

[3]Kitaoka HB，Alexander IJ，Adelaar RS，etal.Clinicalrating systems for the ankle-hindfoot，midfoot，hallux，and lesser toe[J].Foot Ankle Int，1994，15(7)：349.

[4]Ronconi P，Martinelli N，Cancilleri F，etal.Hemiarthroplasty and distal oblique first metatarsal osteotomy for halluxrigidus[J].Foot Ankle Int，2011，32(2)：148-152.

[6]Mann RA.Bunion surgery：decision making[J].Orthopedics，1990，13(9)：951-957.

[8]聶繼平，白志剛，喬成鋼，等.軟組織松解聯(lián)合Chevron、Akin截骨治療輕中度拇外翻[J].內(nèi)蒙古醫(yī)科大學(xué)學(xué)報(bào)，2015，37(2)：170-172.

[9]Choi YR，Lee HS，Jeong JJ，etal.Hallux valgus correction using transarticular lateral release with distal chevron osteotomy [J].Foot Ankle Int，2012，33(10)：838-843.

[10]Ahn JY，Lee HS，Chun H，etal.Comparison of open lateral release and transarticular lateral release in distal chevron metatarsal osteotomy for halluxvalgus correction [J].Int Orthop，2013，37(9)：1781-1787.

Lateral Soft Tissue Release Combined with Austin and Akin Osteotomy Using Medial Approach for the Treatment of Moderate Hallux Valgus

Zhang Shengbing1，Zhang Hongtao2*，Niu Junjie2

(1.Department of Orthopaedics，The Second Chinese Medicine Hospital of Wuxi ，Wuxi 214121；2.Department of Orthopaedics，F(xiàn)irst Affiliated Hospital of Soochow University，Suzhou 215006，China)

ObjectiveTo analyze the therapeutic effect of lateral soft tissue release combined with Austin and Akin osteotomy using medial approach for the treatment of moderate hallux valgus.MethodsWe retrospectively analyzed 30 patients with 33 feet of moderate hallux valgus who were treated by lateral soft tissue release combined with Austin and Akin osteotomy using medial approach from January 2013 to May 2015.All the patients underwent anteroposterior X-ray images in weight loading of involved feet to measure hallux valgus angle (HVA) and intermetatarsal angle (IMA) preoperatively and postoperatively.The function of involved feet were evaluated using front foot scoring system of American Orthopaedic Foot and Ankle Society (AOFAS) preoperatively and postoperatively.ResultsAll the patients were followed up for an average of 13.9 months (ranged from 6 to 25 months).Only one patient was performed second metatarsal Weil osteotomy due to transferred plantalgia postoperatively，other 29 patients were all very satisfied with the surgery.No dorsalis pedis numbness，hallux varus，metatarsal transferred pain，nonunion or recurrence of hallux valgus was presented.HVA was corrected from (33.5±6.4)° preoperatively to (11.0±4.5)° postoperatively (P<0.05).IMA (from 13.6±2.5° to 7.4±2.3°，P<0.05) and AOFAS score (from 39±8.5 to 87±9.3，P<0.05) were also improved postoperatively.ConclusionLateral soft tissue release combined with Austin and Akin osteotomy using medial approach is effective in treating moderate hallux valgus.It can also prevent formation of dorsalis pedis scars and damage of local cutaneous nerves and vessels.

medial approach；soft tissue release；osteotomy；hallux valgus

1008-5572(2016)08-0693-04

R687.3

B

2016-02-16

張圣兵(1973- )，男，副主任醫(yī)師，江蘇省無錫市第二中醫(yī)醫(yī)院骨科，214121。

*本文通訊作者：張洪濤