(足母)外翻籽骨位置变化及与跖趾关节功能关系的相关研究

[目的]探讨躅外翻足手术前、后籽骨位置的变化,及其与跖趾关节功能的关系.[方法]选取80只足(外翻足39只、正常足41只)作为研究对象,参考正常足籽骨位置,对足母外翻手术前、后籽骨到第2跖骨的距离、籽骨相对于第1跖骨的位置、第1跖趾关节功能的评分别行t检验.[结果]正常足、(足母)外翻足手术前、后,籽骨到第2跖骨干的距离比较P值均大于0.05,差异无统计学意义;(足母)外翻足手术前后,籽骨相对于第1跖骨的位置变化、第1跖趾关节功能评分比较P值均小于0.01,差异有统计学意义.[结论]籽骨相对于第1跖骨的位置和跖趾关节评分关系密切,手术前、后发生显著变化,籽骨相对于第2跖骨位置不发生变化.     

参与第1跖趾关系的籽骨软骨软化症

目的 探讨籽骨软骨软化症的病因、病理。方法 对经病理学明确诊断的４例籽骨退行性改变患者进行回顾性分析，结合足部解剖及生物力学特点探讨病因及病理。结果 ４例均因长期穿尖头高跟鞋，产生强制性拇外翻及跖趾关节过度背伸，这种不正常的力学载最终导致籽骨软骨软化。结论籽骨软骨软化症主要病因可能来地两种效应即“弓弦效应”和“高弓效应”。     

参与第1跖趾关节的籽骨软骨软化症

目的　探讨籽骨软骨软化症的病因、病理。方法　对经病理学明确诊断的４ 例籽骨退行性改变患者进行回顾性分析, 结合足部解剖及生物力学特点探讨病因及病理。结果　４ 例均因长期穿尖头高跟鞋,产生强制性拇外翻及跖趾关节过度背伸,这种不正常的力学载荷最终导致籽骨软骨软化。结论　籽骨软骨软化症主要病因可能来源于两种效应即“弓弦效应”和“高弓效应”。     

重塑第一跖趾关节骨形态治疗(足母)外翻

目的评价Keller手术治疗外翻术中重塑第1跖趾关节骨形态的生理活动解剖结构变化。方法2004年4月～2006年11月,采用Keller手术术中重塑第1跖趾关节面骨形态方法治疗外翻11例22足。男3例,女8例;年龄51～73岁。跖趾关节面分型采用Piggot法:型偏斜型17足,型半脱位型5足。外翻角(hallux valgus angle,HVA)24～49°,平均37°;第1跖间角(intermetatarsal angle,IMA)角9.0～13.5°,平均11.5°。结果术后11例22足均获随访6～30个月,平均14个月。参照朱丽华等评定标准:优18足,良3足,差1足。X线片示,14足形成第1跖趾杵臼样假关节,8足假关节面部分咬合。术后HVA7～16°,平均11°;IMA9.0～13.5°,平均11.5°。术后跖趾关节面Piggot法分型:型适合型12足,型偏斜型10足。结论Keller手术中重塑第1跖趾关节骨形态对外翻术后HAV的纠正及症状改善,及关节稳定性有良好改善,减少了术后肌力不足的发生。     

第1 跖趾关节融合术治疗中重度足拇外翻合并第1 跖趾关节炎

目的 探讨第1 跖趾关节融合术治疗中重度足拇外翻合并第1 跖趾关节炎的临床疗效.方法 2016 年6 月至2018 年9 月北京中医药大学第三附属医院采用第 1 跖趾关节融合术治疗中重度足拇外翻合并第 1 跖趾关节炎患者26 例.手术前后于足负重位X线片上测量足拇外翻角(HVA)和第1 、2 跖骨间角(IMA),采用疼...     

第1跖趾关节融合术联合跖趾关节成形术治疗老年拇外翻

目的总结第1跖趾关节融合术联合跖趾关节成形术治疗老年拇外翻的临床疗效。方法采用第1跖趾关节融合术矫正18例老年拇外翻患者(20足),并对第2～5趾畸形行跖趾关节成形术,比较术前及末次随访时拇外翻角(HVA)和第1、2跖骨间角(IMA),应用AOFAS评分系统评价临床疗效。结果患者均获得随访,时间9～24个月。末次随访时,矫形足负重正、侧位X线片显示HVA和IMA均较术前显著减小(P 0. 001);根据AOFAS评分标准评价临床疗效:优1足,良17足,可2足,治疗优良率为18/20。结论第1跖趾关节融合术联合跖趾关节成形术可有效矫正老年拇外翻前足畸形,减轻疼痛,降低术后前足疼痛的复发率。     

正常足与(足母)外翻足横弓形态的对比性研究

[目的]比较研究正常足和外翻足横弓的形态,探讨横弓在外翻发生发展中的作用。[方法]对35名外翻患者65只足和30名正常人60只足,在负重位和非负重位足正位X线片和前足轴位X线片上分别测量外翻角(hallux valgus angle,HVA),第1、2跖骨间角(fist intermetatarsalangle,IMA),各跖骨头、籽骨到足底的距离。[结果]外翻足HVA平均30·8±8.9°,第1、2跖骨间角为16.5±2·6°;正常足HVA为10·2±2·0°,第1、2跖骨间角7·9±1·6°。外翻足与正常足比较第1跖骨头向下移位,第2、3跖骨头距足底的距离明显低于正常足。腓侧籽骨向外上方移位,胫侧籽骨向外侧移位。[结论]外翻足横弓塌陷,籽骨脱位,第2、3跖骨头过早、过重负重易产生疲劳性骨折、跖骨痛和足底胼胝体。     

双侧足母趾籽骨对足母趾外翻矫正手术效果的影响研究

目的 探讨足母趾胫侧籽骨及腓侧籽骨对足母趾外翻矫正手术效果的影响。方法 回顾性分析2010年1月至2013年12月来我院接受近端或远端Chevron截骨矫正治疗的110例足母趾外翻病人。根据病人有无双侧足母趾籽骨分为双侧足母趾籽骨组（30例）和非双侧足母趾籽骨组（80例）。其中,双侧足母趾籽骨组行跖骨近端Chevron截骨矫正治疗4例,跖骨远端Chevron截骨矫正治疗26例;非双侧足母趾籽骨组行跖骨近端Chevron截骨矫正治疗15例,跖骨远端Chevron截骨矫正治疗65例。记录并比较两组病人术前一般资料,手术前后影像学资料测量足母趾外翻角、跖骨间夹角、跖骨远端关节面固有角,比较其手术前后及组间的美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society, AOFAS）踝与后足功能评分。结果 两组病人术后足母趾外翻情况均明显改善。两组病人术后的足母趾外翻角、跖骨间夹角、跖骨远端关节面固有角及AOFAS评分均较术前明显改善;但上述指标组间比较,差异均无统计学意义（P＞0.05）。结论 双侧足母趾籽骨对近端或远端Chevron截骨矫形治疗足母趾外翻畸形手术无明显影响。     

第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻

目的：探讨第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻临床疗效。方法：回顾性分析自2017年3月至2021年8月接受第1跖趾关节融合结合旋转Weil截骨治疗的重度跖内收型拇外翻患者37例（69足）,男8例（11足）,女29例（58足）;年龄67～83(70.03±2.87)岁;左侧3例,右侧2例,双侧32例。分别于术前、术后6周及末次随访时,采用疼痛视觉模拟评分（visual analogue scale,VAS）进行疼痛缓解程度评价。术前及末次随访时采用美国骨科足踝外科学会（American Orthopaedic Foot and Ankle Surgery,AOFAS）前足评分对患足功能进行评价。并测量手术前及末次随访时拇外翻角（hallux valgus angle,HVA）,第1、2跖间角（intermetatarsal angle,IMA）的变化情况。结果：37例（69足）患者获得随访,时间12～48 (22.8±0.6)个月。术后7～10(8.00±1.21)周第1跖趾关节处达到骨愈合,无延迟愈合及不愈合发生。术前HVA (44.30±2.84)°与...     

第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻

目的探讨第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻的临床疗效。方法对12例重度拇外翻畸形患者(14足)采用第1跖趾关节融合结合Weil截骨或关节成形术治疗。结果患者均获得随访,时间6~44个月。术后患足外形均得到良好改善,13足拇外翻疼痛及跖痛消失,第2~5跖骨头下顽固性角化症、硬性胼底消失;1足出现第5跖骨外侧转移性跖痛,经垫前足减压垫缓解。术后患者跖趾关节有不同程度僵硬,经主、被动关节锻炼后,足趾活动度均有改善,未影响日常活动,患者步态及穿鞋要求均获得明显改善。末次随访时,患足AOFAS评分85.48分±2.97分,VAS评分2.41分±0.47分,HVA 14.93°±5.35°,IMA 9.68°±1.87°,各项指标均较术前明显改善(P0.01)。结论采用第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻畸形,能明显改善前足外形,缓解前足行走疼痛,改善肢体功能,提高患者生活质量。     

Effect of metatarsophalangeal joint position on the reliability of the tangential sesamoid view in determining sesamoid position

BACKGROUND: Lateral displacement of the sesamoids of the first toe relative to the metatarsal head is a common finding in hallux valgus deformity. Several methods have been described for quantifying the amount of subluxation from anteroposterior radiographs but a tangential sesamoid radiograph has been determined to be the best view to evaluate sesamoid displacement. METHOD: We evaluated the sesamoid position at different angles of the first metatarsophalangeal (MTP) joint to determine the effect of first MTP joint dorsiflexion on sesamoid position when tangential sesamoid view radiographs are made. Sesamoid positions of 22 feet with hallux valgus were graded from the short axis computed tomography (CT) images obtained with the MTP joint in 0, 35, and 70 degrees of dorsiflexion. RESULTS: Approximation of the sesamoids to reduction was apparent as dorsiflexion of the first MTP joint increased. CONCLUSION: Different dorsiflexion degrees of the first MTP joint when tangential sesamoid radiographs are made modulate the position of the sesamoids and may lead to misclassification on grading.     

Arthrodesis for degenerative disease of the hallux metatarsophalangeal and interphalangeal joints

Arthrodesis of the hallux metatarsophalangeal (MTP) or interphalangeal (IP) joint is a sound surgical solution to degenerative disease of these joints. Where conservative measures have failed, MTP or IP arthrodesis can alleviate pain and normalize gait. Preoperative planning should include evaluation of the skin, bone quality, and range of motion of the involved and adjacent joints. The technique of joint preparation described allows for easily individualized fusion position and maintenance of length. In patients with adequate bone stock, the fixation techniques described provide for compression and obviate the need for removal for most patients. Where bone stock is questionable, plate fixation can provide stability, improving results. With careful patient selection, preoperative planning, and conservative postoperative care, predictable results can be obtained with these techniques.     

籽骨系统与拇外翻

籽骨系统包括胫腓侧籽骨及相关肌肉韧带,其中拇短屈肌、拇收肌、拇展肌在籽骨系统生物力学平衡中发挥着重要作用.籽骨的各种病理变化如籽骨骨髓炎、籽骨骨折、多分籽骨、籽骨骨膜外软骨瘤与拇外翻的发生可能具有一定关系.籽骨脱位和半脱位在拇外翻发生发展机制中占据重要地位,其影像学分级系统被部分学者用于拇外翻术前诊断和术后预后的评估,但至今仍不为大多数骨科医生所熟识.基于X线前后位片的籽骨分级系统,测量的精确性受到质疑,而籽骨轴位片同样可能存在误差,至今仍没有一种完善的籽骨脱位和半脱位测量的影像学技术.籽骨旋转角和MRI评估籽骨系统是近年来新的尝试.     

Effect of sesamoid position on long-term results of hallux abducto valgus surgery

Radiographic parameters for 70 patients that underwent hallux abducto valgus (HAV) surgery were evaluated with emphasis on the tibial sesamoid position. The preoperative and postoperative sesamoid positions were analyzed. Soft tissue bunionectomies, metatarsal head and base osteotomies, and first metatarsocuneiform arthrodesis are procedures that were included in this evaluation. The inadequate relocation of the sesamoids, along with other standard parameters, were then correlated with recurrence of hallux abducto valgus and metatarsus primus adductus. The surgical relocation of the sesamoid apparatus is discussed, including both an intracapsular and extracapsular release. Possible indications for fibular sesamoidectomy are suggested. Effects of sesamoid position on the long-term results of HAV surgery are presented.     

Lateral sesamoid position in hallux valgus: Correlation with the conventional radiological assessment

Background

We aimed to quantify the severity of the hallux valgus based on the lateral sesamoid position and to establish a correlation of our simple assessment method with the conventional radiological assessments.

Methods

We reviewed one hundred and twenty two dorso-plantar weight bearing radiographs of feet. The intermetatarsal and hallux valgus angles were measured by the conventional methods; and the position of lateral sesamoid in relation to first metatarsal neck was assessed by our new and simple method.

Results

Significant correlation was noted between intermetatarsal angle and lateral sesamoid position (Rho 0.74, p < 0.0001); lateral sesamoid position and hallux valgus angle (Rho 0.56, p < 0.0001). Similar trends were noted in different grades of severity of hallux valgus in all the three methods of assessment.

Conclusions

Our method of assessing hallux valgus deformity based on the lateral sesamoid position is simple, less time consuming and has statistically significant correlation with that of the established conventional radiological measurements.     

Arthroscopy of the hallux metatarsophalangeal joint

Despite the paucity of literature on the subject of first MTP joint arthroscopy, the literature that does exist suggests that it is a worthwhile procedure in certain well-selected patients. These patients are usually young to middle-aged and have persistent pain and swelling of the first MTP joint that has failed to respond to conservative measures. These patients in general are too good for arthrodesis or arthroplasty, and certainly in the authors' experience, the results have been highly satisfactory.