Flamme C H, Wülker N, Kuckerts K, Rühmann O
Orthopädische Klinik, Medizinische Hochschule Hannover.
Z Orthop Ihre Grenzgeb. 1998 May-Jun;136(3):250-4. doi: 10.1055/s-2008-1054231.
Resection arthroplasty of the first metatarsal-phalangeal joint is a wellknown operation for hallux valgus. The follow-up results more than 17 years after arthroplasty are recorded and discussed.
Between 1971 and 1980, 335 arthroplasties were performed on 205 patients. The only indication for arthroplasty of the great toe was hallux valgus. The technique of arthroplasty was according to Keller-Brandes. 102 patients were reexamined clinically and radiographically, after 17.6 years on average.
Questionnaire assessment revealed a significantly prolonged walking distance and 70% of the patients were painfree at the time of investigation, whereas 67% suffered from severe pain before operation. Clinical evaluation showed diminished weightbearing of the great toe during walking and a reduced range of motion of the partial-resected first metatarsal-phalangeal joint. Radiographically the shortening of the phalangeal bone of 37% was evident as expected. Hallux-valgus-angle was 23 degrees at the time of investigation and 34 degrees preoperatively in the mean.
The high rate of hallux valgus relapse, especially due to a high intermetatarsal angle demonstrate unsatisfactory longterm results by the Keller-Brandes operation. We now recommend this operation for older patients and a differentiated approach according to the clinical and radiographical situation for younger patients.
第一跖趾关节切除关节成形术是治疗拇外翻的一种知名手术。本文记录并讨论了关节成形术后17年以上的随访结果。
1971年至1980年间，对205例患者进行了335例关节成形术。拇趾关节成形术的唯一适应症是拇外翻。关节成形术技术采用凯勒-布兰德氏法。平均17.6年后，对102例患者进行了临床和影像学复查。
问卷调查评估显示步行距离明显延长，70%的患者在调查时无疼痛，而67%的患者术前患有严重疼痛。临床评估显示，步行时拇趾负重减轻，部分切除的第一跖趾关节活动范围减小。影像学检查显示，趾骨缩短37%，与预期一致。调查时拇外翻角平均为23度，术前为34度。
拇外翻复发率高，尤其是由于跖间角大，表明凯勒-布兰德氏手术的长期效果不理想。我们现在建议对老年患者采用这种手术，对年轻患者根据临床和影像学情况采用不同的方法。
