Jenter M, Lipton G E, Miller F
The Alfred I. duPont Institute, Wilmington, Delaware 19899, USA.
Foot Ankle Int. 1998 Dec;19(12):830-5. doi: 10.1177/107110079801901207.
All patients with cerebral palsy who had hallux valgus and bunion deformities surgically corrected between 1986 and 1995 were reviewed to determine whether techniques other than arthrodesis of the first metatarsophalangeal joint would adequately correct these deformities. Twenty-six feet of 17 patients were surgically corrected for their bunions and/or their hallux valgus deformity. The mean hallux valgus angle for all children was 30 degrees, preoperatively, with 70% correction achieved. Four techniques of surgical correction were used. A first metatarsophalangeal joint arthrodesis on eight feet gave excellent outcomes for all using the duPont Bunion Rating Score and a mean of 89% correction of the hallux valgus angle. A proximal first metatarsal osteotomy, distal soft tissue release, and exostectomy of the bunion on five feet gave three excellent and two fair outcomes, with a mean of 83% correction of the hallux valgus angle. A distal soft tissue release and exostectomy on eight feet gave four excellent outcomes, two good outcomes, and two fair outcomes, with a mean of 53% correction of the hallux valgus angle. An osteotomy of the first proximal phalanx, metatarosphalageal soft tissue release, and exostectomy on five feet gave three excellent outcomes, one good outcome, and one fair outcome with a mean of 36% correction of the hallux valgus angle. All patients who met the criteria for the procedures were satisfied with the outcomes; however, the first metatarosphalageal joint arthrodesis gave the best results with the highest percent correction and bunion score.
对1986年至1995年间接受拇外翻和拇囊炎畸形手术矫正的所有脑瘫患者进行了回顾，以确定第一跖趾关节融合术以外的技术是否能充分矫正这些畸形。17名患者的26只脚接受了拇囊炎和/或拇外翻畸形的手术矫正。所有儿童术前平均拇外翻角度为30度，术后矫正率达70%。采用了四种手术矫正技术。对8只脚进行第一跖趾关节融合术，根据杜邦拇囊炎评分系统，所有病例效果均极佳，拇外翻角度平均矫正率达89%。对5只脚进行第一跖骨近端截骨、远端软组织松解和拇囊炎骨赘切除术，结果为3例极佳、2例尚可，拇外翻角度平均矫正率为83%。对8只脚进行远端软组织松解和骨赘切除术，结果为4例极佳、2例良好、2例尚可，拇外翻角度平均矫正率为53%。对5只脚进行第一近端趾骨截骨、跖趾关节软组织松解和骨赘切除术，结果为3例极佳、1例良好、1例尚可，拇外翻角度平均矫正率为36%。所有符合手术标准的患者对手术结果均满意；然而，第一跖趾关节融合术效果最佳，矫正率最高，拇囊炎评分也最高。
