旋转骨赘切除联合 Akin 截骨术治疗拇外翻：50 例患者 9 年的随访研究
Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients.
机构信息
Hillsborough Private Clinic, Hillsborough, Co Down, Northern Ireland BT26 6AE, UK.
出版信息
J Foot Ankle Res. 2010 Feb 15;3:2. doi: 10.1186/1757-1146-3-2.
BACKGROUND
The Cochrane review of hallux valgus surgery has disputed the scientific validity of hallux valgus research. Scoring systems and surrogate measures such as x-ray angles are commonly reported at just one year post operatively but these are of dubious relevance to the patient. In this study we extended the follow up to a minimum of 8 years and sought to address patient specific concerns with hallux valgus surgery. The long term follow up also allowed a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies.
METHODS
Between 1996 and 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. All patients were contacted and asked to participate in this study. 50 female participants were available allowing review of 73 procedures. The average follow up was over 9 years and the average age at the time of surgery was 57. The participants were physically examined and interviewed.
RESULTS
Post-operatively, in 86% of the participants there were no footwear restrictions. Stiffness of the first metatarsophalangeal joint was reported in 8% (6 feet); 10% were unhappy with the cosmetic appearance of their feet, 3 feet had hallux varus, and 2 feet had recurrent hallux valgus. There were no foot-related activity restrictions in 92% of the group. Metatarsalgia occurred in 4% (3 feet). 96% were better than before surgery and 88% were completely satisfied with their post-operative result. Hallux varus was the greatest single cause of dissatisfaction. The most common adverse event in the study was internal fixation irritation. Hallux valgus surgery is not without risk and these findings could be useful in the informed consent process.
CONCLUSIONS
When combined the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that achieves good long-term correction with a low incidence of recurrence, footwear restriction or metatarsalgia. The nature of the osteotomies allows early return to normal shoes and activity without the need for postoperative immobilisation in a plaster cast.
背景
Cochrane 对拇外翻手术的综述对拇外翻研究的科学有效性提出了质疑。评分系统和替代指标，如 X 射线角度，通常在术后一年仅报告一次，但这些与患者的相关性值得怀疑。在这项研究中，我们将随访时间延长至至少 8 年，并试图解决拇外翻手术的具体问题。长期随访还允许全面审查与旋转皮瓣和 Akin 截骨术相关的并发症。
方法
1996 年至 1999 年，101 例患者接受旋转皮瓣和 Akin 截骨术治疗拇外翻。所有患者均被联系并邀请参加这项研究。有 50 名女性参与者可供评估，共评估了 73 例手术。平均随访时间超过 9 年，手术时的平均年龄为 57 岁。参与者接受了体格检查和访谈。
结果
术后，86%的参与者没有穿鞋限制。8%（6 例）报告第一跖趾关节僵硬；10%对脚部的外观不满意，3 例有拇内翻，2 例有拇外翻复发。92%的患者无足部活动受限。4%（3 例）出现跖痛症。96%的患者比手术前好，88%的患者对术后结果完全满意。拇内翻是最不满意的单一原因。研究中最常见的不良事件是内固定刺激。拇外翻手术并非没有风险，这些发现可能有助于知情同意过程。
结论
当旋转皮瓣和 Akin 截骨术联合应用时，是治疗拇外翻的有效方法，可长期获得良好的矫正效果，复发率低，穿鞋受限或跖痛症发生率低。截骨术的性质允许早期返回正常鞋子和活动，而无需术后在石膏固定中固定。
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