Sangeorzan B J, Hansen S T
Department of Orthopaedics, Harborview Medical Center, Seattle, WA 98104.
Foot Ankle. 1989 Jun;9(6):262-6. doi: 10.1177/107110078900900602.
A modified Lapidus procedure was introduced at Harborview Medical Center in 1979 for the treatment of symptomatic hallux valgus with hypermobile first ray. The results of the procedures were reviewed retrospectively in 32 patients with 40 feet that were operated on between 1979 and 1984. Preoperative diagnosis was symptomatic hallux valgus complex with hypermobile first ray in 33 and failed bunion surgery in 7. Follow-up ranged from 30 months to 6 1/2 years. Union of the arthrodesis site occurred in 36 (90%). The average preoperative intrametatarsal angle was 14 degrees (range 7.5 to 20 degrees) and the hallux valgus angle was 26 degrees (range 0 to 50 degrees). At healing, the angles were as follows: intermetatarsal angle 6 degrees (range 0 to 18 degrees) and hallux valgus angle 11 degrees (range -3 to 30 degrees). The average change in the length of the first metatarsal was -5 mm for those without bone graft and +4 mm for those with bone graft. Of 33 feet operated on as a primary procedure, successful results were reported in 75% by our rating system. Of 7 feet operated on for failed previous surgery, all were improved. Best results were obtained in those with multiple screw fixation, use of bone graft, and attention to plantarflexion of the first metatarsal.
1979年，港湾景医疗中心引入了改良的拉皮德斯手术，用于治疗伴有第一跖趾关节活动过度的症状性拇外翻。对1979年至1984年间接受手术的32例患者的40只脚进行了回顾性研究，以评估该手术的效果。术前诊断为伴有第一跖趾关节活动过度的症状性拇外翻综合征33例，拇囊炎手术失败7例。随访时间为30个月至6年半。关节固定部位愈合的有36例（90%）。术前第一跖骨间角平均为14度（范围7.5至20度），拇外翻角为26度（范围0至50度）。愈合时，角度如下：第一跖骨间角6度（范围0至18度），拇外翻角11度（范围-3至30度）。未进行植骨的患者第一跖骨长度平均变化为-5毫米，进行植骨的患者为+4毫米。在作为初次手术的33只脚中，根据我们的评分系统，75%的患者取得了成功的结果。在因先前手术失败而接受手术的7只脚中，所有患者的情况均有改善。采用多枚螺钉固定、使用植骨并注意第一跖骨跖屈的患者取得了最佳效果。
