内侧单切口撑开器辅助下外侧软组织松解联合Scarf截骨治疗中重度足拇外翻

目的探讨经单一内侧切口撑开器辅助下行外侧软组织松解联合第1跖骨Scarf截骨治疗中重度足拇外翻的手术疗效。方法自2011-12—2012-12诊治22例（25足）中重度足拇外翻,于第1跖骨内侧作单一切口,远端延长至第1跖趾关节,撑开器辅助下行外侧软组织松解及Scarf截骨矫正。结果 20例（23足）获得随访12-24个月,平均14个月。截骨愈合时间10-13周,平均11.5周。术前拇外翻角（HVA）30.3°-51.5°（40.0±5.6）°,第1、2跖骨间夹角（IMA）15.0°-21.4°（18.6±1.8）°,AOFAS评分41.7-67.1（55.9±6.0）分;末次随访时HVA 5.8°-21.4°（13.3±4.0）°,IMA 6.2°-12.9°（10.8±1.8）°,AOFAS评分80.5-96.2（87.3±4.6）分,均较术前明显改善,差异有统计学意义（P〈0.05）。结论撑开器辅助下内侧单切口外侧软组织松解联合Scarf截骨能有效矫正中重度足拇外翻畸形,撑开器辅助下内侧单切口显露清楚、创伤小且外形更加美观。

Treatment of moderate to severe hallux valgus using Scarf osteotomy and lateral soft-tissue release assisted by a distractor through a medial incision

Objective To investigate the therapeutic outcomes of Scarf osteotomy combined with lateral soft-tissue release assisted by a distractor through a single medial incision for treating moderate to severe hallux valgus. Methods Twenty two patients（25 feet） with moderate to severe hallux valgus were treated from December 2011 to December 2012. A longitudinal medial incision extending to the first metatarsophalangeal joint was made alone the first metatarsal. Scarf osteotomy was performed after the lateral soft-tissues were released. Results Twenty patients（23 feet） were followed up for 14 months in average（range, 12 to 24 months）. The mean time of bone union was 11.5 weeks（range 10 to 13 weeks）. Before operation, the hallux valgus angle（HVA） was（40.0±5.6）°, and the first and second intermetatarsal angle（IMA） was（18.6±1.8）°, and the AOFAS scores was（55.9±6.0）points. At the final follow-up, the HVA was（13.3±4.0）°, the IMA was（10.8±1.8）°, the AOFAS scores was（87.3±4.6）points, showing significant difference when compared with the preoperative value（P〈0.05）. Conclusion Scarf osteotomy combined with lateral soft-tissue release assisted by a distractor through a single medial incision can effectively correct the moderate to severe hallux valgus, and this method could achieve fully exposure, avoid the scar and improve the cosmetic results.