Waizy H, Stukenborg-Colsman C, Abbara-Czardybon M, Emmerich J, Windhagen H, Frank D
Orthopädische Klinik der Medizinischen Hochschule Hannover im Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland.
Oper Orthop Traumatol. 2011 Feb;23(1):46-51. doi: 10.1007/s00064-010-0005-7.
Maintaining the corrected position of the first metatasophalangeal axis. Reducing postoperative stiffness by forgoing a medial capsular shift.
Hallux valgus deformities or recurrent hallux valgus deformities.
Existing osteoarthritis, joint stiffness, large bone defects, osteonecrosis. General medical contraindications to surgical interventions and anesthesiological procedures.
Operation under regional anesthesia (foot block) or general anesthesia. Tourniquet. Longitudinal skin incision medial over the pseudexostosis of the first metatarsal bone. Preparing the tendon of the Musculus abductor hallucis. Detaching the tendon from the capsule. Incision of the joint capsule with protection of the extensor hallucis longus tendon and the dorsal neurovascular bundle in an L-wise manner. Osteotomy of the first metatarsal bone. Lax sutures of the capsule in correct position and reattachment of the Musculus abductor hallucis tendon shifted toward distal and dorsal, regarding the rotation of the hallux.
Postoperative elevation of the operated foot. Analgesia with nonsteroidal antiinflammatory drugs. Postoperative weight-bearing according to the osteotomy. Passive mobilization of the metatarsophalangeal joint. Dressing for 4 weeks postoperatively in the corrected position. Radiologic control after 6 weeks. Hallux valgus orthosis at night and a toe spreader for a further 6 weeks.
A total of 30 isolated hallux valgus deformities with a mean preoperative intermetatarsal (IMA) angle of 12.9° (range 11-15°) were operated with a chevron osteotomy. The mean follow-up was 14.4 (range 8-17) months. The mean dorsiflexion at the last follow-up was 44° (range 20-60°). Only 2 patients had a dorsiflexion <40°. The mean reduction of the IM angle was 5.6° (range 3-7°). One patient required wound revision. There was no infection or avascular necrosis of the metatarsal head observed in the patients. At follow-up, 20 (67%) patients were completely satisfied, 9 (30%) satisfied, and 1 (3%) was not satisfied.
维持第一跖趾关节轴线的矫正位置。通过不进行内侧关节囊移位来减少术后僵硬。
拇外翻畸形或复发性拇外翻畸形。
存在骨关节炎、关节僵硬、大的骨缺损、骨坏死。手术干预和麻醉程序的一般医学禁忌症。
在区域麻醉（足部阻滞）或全身麻醉下进行手术。使用止血带。在第一跖骨假外生骨上方内侧做纵向皮肤切口。准备拇展肌肌腱。将肌腱从关节囊分离。以L形方式切开关节囊，同时保护拇长伸肌腱和背侧神经血管束。第一跖骨截骨术。将关节囊在正确位置进行松弛缝合，并将拇展肌肌腱向远侧和背侧重新附着，同时考虑拇趾的旋转。
术后将手术足抬高。使用非甾体类抗炎药止痛。根据截骨情况决定术后负重。被动活动跖趾关节。术后4周在矫正位置包扎。6周后进行影像学检查。夜间佩戴拇外翻矫形器，并继续使用脚趾撑开器6周。
共有30例孤立性拇外翻畸形患者接受了V形截骨术，术前平均跖间角（IMA）为12.9°（范围11 - 15°）。平均随访时间为14.4（范围8 - 17）个月。最后一次随访时的平均背屈角度为44°（范围20 - 60°）。只有2例患者背屈角度<40°。IMA角度平均减小5.6°（范围3 - 7°）。1例患者需要伤口修复。患者中未观察到跖骨头感染或缺血性坏死。随访时，20例（67%）患者完全满意，9例（30%）满意，1例（3%）不满意。
