拇收肌和拇展肌移位吻接重建前足横弓治疗拇外翻的临床研究

发布时间：2018-04-05 11:28

本文选题：拇外翻　切入点：前足横弓　出处：《吉林大学》2015年硕士论文

【摘要】：目的探讨拇收肌和拇展肌移位吻接重建足横弓治疗拇外翻畸形的临床疗效。资料与方法回顾分析2012年1月—2014年10月，采用拇收肌和拇展肌移位吻接重建足横弓治疗拇外翻18例（26足），男1例（1足），女17例（25足）；年龄19～66岁，平均47.1岁。单足10例，双足8例。病程1～17年，平均5.3年。患者均有不同程度拇囊炎表现；15足有明显的足横弓塌陷且合并足底胼胝，3足合并锤状趾畸形。美国足踝外科协会（AOFAS）评分为（57.46±8.01）分。术前X线片示拇外翻角（hallux valgus angle，HVA）（33.92±5.65）°；跖间角（intermetatarsal angle，IMA）（13.73±2.09）°；胫侧籽骨相对位置（tibial sesamoid position，TSP）3.46±1.03。按Mann提出的拇外翻分类标准，轻度6足，中度15足，重度5足。结果术后1例（1足）切口出现感染，其余患者切口均Ⅰ期愈合。2例（3足）出现拇趾麻木。18例均获随访，随访时间6个月～31个月，，平均10个月。末次随访时根据AOFAS评分量表评定疗效：获优14足，良9足，可2足，差1足；优良率为88.4%。末次随访时，HVA为（13.50±3.52）°，IMA为（8.62±2.17）°，胫侧籽骨相对位置（TSP）2.00±0.85，AOFAS评分为（87.85±8.03）分，与术前比较差异均有统计学意义（P=0.00）。伴足横弓塌陷的15足均有一定程度恢复，足底胼胝消失（9足）或变小（6足）。1例（1足）拇外翻复发，无1例出现拇内翻。结论 1、拇收肌和拇展肌移位吻接重建足横弓针对拇外翻主要病理改变进行矫治，取得了较好的临床疗效。 2、此术式能有效减小HVA，IMA，复位脱位的籽骨。 3、此术式能在一定程度上恢复塌陷的前足横弓，消除拇囊炎疼痛及足底胼胝引起的疼痛，足底胼胝变小或消失。
[Abstract]:PurposeTo investigate the clinical effect of transposition of adductor pollicis muscle and abductor pollicis muscle to reconstruct transverse arch of foot in treatment of hallux valgus malformation.Data and methodsFrom January 2012 to October 2014, 18 cases of valgus pollicis valgus were treated by transposition of adductor hallucis muscle and abductor pollicis muscle with transposition of abductor pollicis muscle to reconstruct transverse arch of foot in 26 cases (1 male, 1 foot, 17 female, 25 feet), the age was 1966 years old (mean 47.1 years).Single foot 10 cases, biped 8 cases.The course of disease ranged from 1 to 17 years with an average of 5.3 years.All the patients had different degree of hallucocystitis and 15 feet had obvious collapse of transverse arch of foot and 3 feet of callus plantar with mallet toe deformity.AOFASA score was 57.46 卤8.01.The preoperative radiographs showed that the hallux valgus angle was 33.92 卤5.65 掳, the intermetatarsal angle was 13.73 卤2.09 掳and the relative position of tibial sesamoid was 3.46 卤1.03 掳.According to the classification standard of hallux valgus proposed by Mann, mild 6 feet, moderate 15 feet, severe 5 feet.ResultInfection was found in 1 case (1 foot), and in other cases, the first stage healing of 2 cases (3 feet) and hallux numbness occurred in 18 cases. The follow-up time was 6 months to 31 months, with an average of 10 months.At the last follow-up, the curative effect was evaluated by AOFAS scale: excellent 14 feet, good 9 feet, fair 2 feet, poor 1 foot, and the excellent and good rate was 88.4.At the last follow-up, the HVA was 13.50 卤3.52 掳and the relative position of tibial seed bone was 8.62 卤2.17 掳. The score of AOFAS was 87.85 卤8.03, which was significantly different from that before operation.15 feet with transverse arch collapse recovered to some extent, 9 feet of plantar callus disappeared) or decreased 6 feet (1 case) hallux valgus recurred, no case occurred hallux varus.Conclusion1. The transposition of adductor pollicis and abductor pollicis muscle was performed to reconstruct the transverse arch of the foot in order to correct the main pathological changes of hallux valgus, and a good clinical effect was obtained.2. This procedure can effectively reduce the HVA IMA and reduce the dislocation of the seed bone.3. This procedure can recover the collapsed transverse arch of the forefoot to some extent, eliminate the pain caused by hallucocystitis and callus in the plantar, and decrease or disappear the callus in the plantar floor.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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