Faraj A A
Orthopaedic Department, Medical City, Baghdad Teaching Hospital, Iraq.
J Foot Ankle Surg. 1997 Sep-Oct;36(5):356-9. doi: 10.1016/s1067-2516(97)80036-1.
A prospective study was carried out on 12 patients with postpoliomyelitis clawing of the hallux treated by a modified Jones procedure using Kirschner wire for the interphalangeal joint fusion. The purpose of this study was to evaluate the outcome of a modified Jones procedure in the treatment of postpolio claw hallux deformity. All the patients had symptoms related to the claw hallux deformity; foot biomechanics and gait were affected. Patients were assessed both pre- and postoperatively using Axer's criteria. Mean follow-up was 32 months. Ten patients had very good results and two patients had fair results. The transferred extensor hallucis longus became loose in two patients who had a coexistent tight Achilles tendon. Recurrence of medial cavus deformity occurred 3 months after the operation in both of these patients. This was treated by shortening the transferred extensor hallucis longus after elongating the tight Achilles tendon. No pseudoarthrosis of the interphalangeal joint was identified. When the Jones procedure is performed, the motor power of the extensor hallucis longus should be Medical Research Council Grade V before transfer. The Achilles tendon should be evaluated for equinus preoperatively and lengthened when equinus deformity is present in order to avoid residual foot deformities.
对12例采用改良琼斯手术并用克氏针进行趾间关节融合治疗的小儿麻痹后遗症拇趾爪形畸形患者进行了一项前瞻性研究。本研究的目的是评估改良琼斯手术治疗小儿麻痹后遗症拇趾爪形畸形的疗效。所有患者均有与拇趾爪形畸形相关的症状；足部生物力学和步态均受到影响。采用阿克塞尔标准对患者进行术前和术后评估。平均随访32个月。10例患者效果非常好，2例患者效果尚可。2例跟腱紧张的患者中，移位的拇长伸肌出现松弛。这2例患者术后3个月均出现内侧足弓畸形复发。通过在延长紧张的跟腱后缩短移位的拇长伸肌进行治疗。未发现趾间关节假关节形成。进行琼斯手术时，移位前拇长伸肌的肌力应达到医学研究委员会V级。术前应评估跟腱是否存在马蹄足畸形，存在马蹄足畸形时应进行延长，以避免残留足部畸形。
