Sammarco V James
Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, Ohio, USA.
Instr Course Lect. 2008;57:415-28.
Hallux valgus correction by distal soft-tissue release and proximal metatarsal osteotomy is the procedure of choice for most patients with moderate and severe hallux valgus deformity. Complications can be avoided by selecting a procedure that provides adequate correction of the intermetatarsal angle and ensuring proper balancing of the metatarsophalangeal joint though lateral soft-tissue releases and medial joint plication. Arthrodesis should be considered when revision of failed surgery is planned, degenerative joint disease is present, and where the likelihood of failure of a bunion procedure is high (such as in elderly individuals with osteoporosis, severe deformity with significant involvement of the lesser metatarsophalangeal joint, and when spasticity is present). A review of biomechanical data, clinical studies, and surgical techniques is important for successful treatment of moderate and severe hallux valgus deformity.
对于大多数中重度拇外翻畸形患者而言，通过远端软组织松解和近端跖骨截骨术进行拇外翻矫正术是首选的治疗方法。选择能够充分矫正跖间角的手术，并通过外侧软组织松解和内侧关节折叠来确保跖趾关节的适当平衡，可避免并发症的发生。当计划对失败的手术进行翻修、存在退行性关节疾病以及拇囊炎手术失败可能性较高时（如患有骨质疏松症的老年人、小跖趾关节严重受累的严重畸形患者以及存在痉挛时），应考虑关节融合术。回顾生物力学数据、临床研究和手术技术对于成功治疗中重度拇外翻畸形至关重要。
