单一内侧切口单钉Scarf截骨(或联合Akin截骨)结合外侧软组织松解中重

大 医 生DOCTOR2020年第15期单一内侧切口单钉Scarf截骨（或联合Akin截骨）结合外侧软组织松解中重度拇外翻的临床观察杨 光 朱 康 杜海山（北京市昌平区中医医院，北京 102200）摘要： 目的 探讨经足单一内侧切口行单钉Scarf截骨术（或联合Akin截骨）结合外侧软组织松解中重度拇外翻的临床疗效。方法 选取北京市昌平区中医医院2017年6月到2018年6月手术的中重度拇外翻20例（20足），于第1跖趾关节内侧作单一切口，经第1跖趾关节及跖籽关节间隙分别行外侧软组织松解，并采用同一切口行改良Scarf截骨术，以截骨远端卡槽及干部单一螺钉固定，酌情加用第一近节趾骨的Akin截骨术进一步矫正。对术前1天，术后8周及最后一次随访时分别进行X线检查并对第一、二跖骨间角（IMA）及拇外翻角（HVA）测量，并在最后一次随访进行美国足踝外科学会（AOFAS）的第1趾关节功能评分及疗效评定。结果 20例（20足）均获随访，随访时间12～20个月，平均15个月。术后患者切口均Ⅰ期愈合。2例患者出现术后拇指内侧皮肤麻木。全部患者随访期间未出现拇内翻、跖骨头缺血性坏死、转移性跖骨痛等并发症。X线片检查示截骨处均于8周内达骨性愈合。末次随访时HVA为（11.1±1.3）°，与术前（38.9±2.3）°比较差异有统计学意义（t=22.12，P＜0.01）；IMA角为（10.2 ± 1.7）°，与术前（18.3±2.1）°比较差异亦有统计学意义（t=21.07，P＜0.05）。AOFAS第1跖趾关节评分为（85.3±4.3）分，与术前（52.9±5.7）分比较差异有统计学意义（t=21.75，P＜0.01）。结论 采用足单一内侧切口对中重度拇外翻患者同时进行外侧软组织松解及单钉Scarf截骨（或联合Akin截骨）术，手术创伤小，临床疗效显著，避免足背手术瘢痕对美观的影响，值得推广。关键词： 中重度拇外翻；单一内侧切口；外侧软组织松解；单钉Scarf截骨Clinical Observation on the Treatment of Moderate and Severe Hallux Valgus

by Scarf Osteotomy (or Combined with Akin Osteotomy) and External Soft

Tissue Release with Single Medial Incision and Single ScrewYANG Guang  ZHU Kang  DU Haishan(Beijing Changping District Hospital of Traditional Chinese Medicine, Beijing 102200, China)Abstract：Objective To investigate the clinical effect of single screw Scarf osteotomy (or combined with Akin osteotomy) through a single medial incision of the foot combined with lateral soft tissue lysis in the treatment of moderate to severe hallux valgus. Methods 20 cases (20 feet) of moderate to severe hallux valgus surgically treated in Beijing Changping District Hospital of Traditional Chinese Medicine from June 2017 to June 2018 were selected, and a single incision was made on the inner side of the first metatarsophalangeal joint through the first  joints and metatarsal joint spaces were respectively loosened the lateral soft tissuelysis, and the same incision was used to perform a modified Scarf osteotomy, which was fixed with a single screw at the distal end of the osteotomy. Single-nail Scarf osteotomy, as appropriate, plus Akin osteotomy of the first proximal phalanx for further correction. X-ray examination and IMA angle and HVA angle were measured 1 day before surgery, 8 weeks after surgery and at the last follow-up, and AOFAS first metatarsophalangeal joint function score and efficacy evaluation were performed at the last follow-up. Results All 20 cases (20 feet) were followed up for 12～20 months, with an average of 15 months. All incisions healed by first intention after operation. Two patients postoperative numbness of the inner thumb skin. During the follow-up period of all patients, no complications such as hallux varus, avascular necrosis of the metatarsal head, metastatic metatarsalgia occurred. X-ray examination showed that the osteotomies all achieved bone union within 8 weeks. The HVA at the last follow-up was (11.1±1.3)°, which was significantly different from the preoperative (38.9±2.3)° (t=22.12, P＜0.01); the IMA angle was (10.2±1.7)°, which was significantly different from the preoperative (18.3±2.1)°(t=21.07, P＜0.05). The AOFAS first metatarsophalangeal joint score was (85.3±4.3) points, which was significantly different from the preoperative (52.9±5.7) points (t=21.75, P＜0.01). Conclusion The use of a single medial foot incision for patients with moderate to severe hallux valgus simultaneous lateral soft tissue loosening and single-screw Scarf osteotomy (or combined with Akin osteotomy), the surgical trauma is small, the clinical effect is significant, and the scars of the back of the foot are avoided. The impact on aesthetics is worth ds：moderate to severe hallux valgus; single medial incision; lateral soft tissue lysis; single screw Scarf osteotomy作者简介：杨光，硕士研究生，主治医师，研究方向：骨科临床。·31·