摘要
目的探讨坶内收肌在中老年前足痛与坶外翻畸形形成机理中的作用及改良Keuer截骨矫形手术的疗效。方法（1）对8例25-26cm新鲜成人尸体足标本中坶内收肌的分布、起止点、血供、神经支配及毗邻关系进行了系统解剖学观察。（2）应用改良Keller矫形手术治疗合并第1跖趾关节骨性关节炎的中老年坶外翻患者50例82足，平均年龄55-77岁。术前、术后摄负重位X片，测量罡母外翻角（HVA）、第1，2跖骨间角（IMA）、近端关节固定角（PASA）、远端关节固定角（DASA），观察其变化，并将所得数据进行对比分析。结果解剖学观察发现坶内收肌斜头和横头与跖趾关节关系密切。根据解剖特点，在分析传统Keller术式并发症产生原因的基础上，对其进行有针对性的改良．取得良好效果。50例82足获得完整随访，随访时间1-6年，X片显示HVA从术前的平均51°±12°减小到术后的平均22°±6°IMA从术前的平均15°＋5°减小到术后的平均9°±40°根据美国足踝外科协会Maryland第1跖趾关节百分评分法，评定术后疗效：优90-100分58足（71．6％）。良80-89分22足（22．2％），可70-79分2足，优良率93．8％，无1例发生转移跖骨痛、畸形复发、坶内翻及第1跖骨头缺血坏死等并发症。结论第1跖趾关节骨性关节炎导致的坶内收肌长期、持续痉挛为中老年坶外翻形成、发展及疼痛产生的主要原因，改良keller关节囊内基底截骨矫形手术方法简单，疗效可靠，有效解决疼痛，是治疗骨性关节炎型老年坶外翻一种较好的、安全有效的手术方式，有较大的临床应用推广价值。
Objective To discuss the effect of adductor pollicis in propodium pain and hallux valgus in middle-aged person and old person, and observe the effect of Keller truncation bone orthopedic. Methods （1）Observing the disposition, enyhesis, blood supply, innervation, adjoin of adductor pollicis in 8 fresh adult corpse. （2）Using improved Keller orthopedic surgery to treat old age hallux valgus patients complicated with first metatarso phalangeal joints osseous arthritis in 50 example 82 feet, average age 55- 77 years old. Compared with the weightbearing X-ray measurement change of HVA, IMA, PASA, DASA of planta pressure before and after operation, and contrasted the data change. Results Anatomy observation discovered the relationship between oblique head and the transverse head of adductor pollicis and the first metatarso phalangeal joints was close. According to dissection characteristic, in the analysis the reason of tradition Keller technique type complication, carryed on the target-oriented improvement, obtained the good results. 50 patients of 82 feet obtained the complete follow-up, the follow-up time ranged 1-6 years, X-ray demonstrated that HVA 51°±12°before the operation reduces to average 22°±6° after the operation,IMA 15°±5° before the operation reduces to average 9° ±4° after the operation. According to the American Ankle Surgical department Association Maryland percentage grading law, thecurative effect： Superior： 90~100 points in 58 foot （71.6%）, good： 80-89 points in 22 foot （22.2%）,general： 70-79 points in 2 example, good rate 93.8%, there were no shift metatarsalyia, the abnormal recrudescence, hallux varus and complications and first metatarsal bone ischemia necrosis in any cases. Conclusion Long term and continue spasm of adductor pollicis caused by the first metatarso phalangeal joints osteoarthritis was the main reason of old age hallux valgus. The improved Keller orthopedic surgery method is simple, reliable, effective addressing ache, and it is a good method to treat old age hallux valgus, has the big clinical practice promotion value.
出处
《实用手外科杂志》
2012年第3期231-234,共4页
Journal of Practical Hand Surgery
关键词
前足痛
坶内收肌
外翻畸形
挛缩病变
矫形术
退变性关节炎
Propodiumpain
Adductorpollicis
Halluxvalgus
Contracture
Orthopaedics
Degenerative arthritis
