改良Youngswick手术治疗合并第1跖楔关节不稳的青中年人母外翻.doc

　　改良Youngswick手术治疗合并第1跖楔关节不稳的青中年人母外翻 【摘要】 [目的]探讨改良Youngsodified Youngsy on young and middle-aged hallux valgus∥HU Ling-dong,ZHENG Jian-sen，ZHANG Jun.Department of Orthopaedics，Disabled-soldiers Hospital, Taian, Shandong 271000，China 　　Abstract: [Objective]To evaluate the effect of transverse arch reconstruction by modified Youngsy on young and middle-aged hallux valgus . [Methods]From November 2005 to November 2008 , 25 female (36 feet) hallux valgus patients obility of the first tarsometatarsal joint and collapse of the transverse arch of the foot. In the operation, the first metatarsal head ity . The X-ray films of all patients onths after operation . The hallus valgus angle and intertatarsal angle easured and analyzed on radiographs . The surgical oute ameters onth. Hallax valgus angle reduced from 26.8°±1.07° to 11.1°±0.29°, intertatarsal angle reduced from 14.9°±1.36° preoperatively to 8.3°±1.19° postoperatively. The painful callus beneath the forefoot inished obviously in all cases . Based on Gu Xiangjie’score , the subjective assessments obility of the first tarsometatarsal joint and transversal arch collapse , modified Youngsetatarsal adduct abnormality , and regain the etatarsal head.Modified Youngsiddle-aged hallux valgus because of less plications and reliable surgery outes. 　　Key etatarsal joint; osteotomy 　　临床上不少母外翻患者伴有不同程度的第1跖楔关节的不稳定，第1跖楔关节的不稳定表现为第1跖骨的过度活动和中央跖骨头下的伴有疼痛性或无疼痛性的胼胝，第1跖楔关节融合术是临床治疗此类疾病的常用方法，但此手术技术难度大，并发症多，术后恢复时间长，约需1年的时间患者才能恢复正常工作，青中年患者大多难以接受;2005年11月～2008年11月，采用改良Youngs;纵向切开第1跖趾关节外侧关节囊和籽骨悬韧带，根据腓侧籽骨复位与否决定是否切断跖间横韧带，再小范围横行切开第1跖趾关节外侧关节囊，内翻母趾，进一步松解关节外侧软组织，使第1跖趾关节在 自然 状态下能处于正常的生理位置上，以外翻5°～10°为最理想;L形切开内侧关节囊，充分显露第1跖骨头内侧骨赘，垂直于跖骨冠状面、平行于跖骨矢状面、于冠状沟内侧约1 mm的位置切除骨赘，再于跖骨内侧矢状截骨面上，作一顶点向远端的V形冠状位截骨，截骨顶点距关节面1 cm左右，两V形截骨面间的夹角约为80°～90°，V形的上下两臂尽量等长，再在近端上截骨面的背侧以第1跖骨背侧的骨皮质为顶点、基底在近端下截骨面上的楔形截骨，基底长约2～3 mm(见图1～2)，去除楔形截骨块，将第1跖骨头向跖侧下移并旋转，修整第一跖骨近端下截骨面，直至与跖骨头上下两截骨面能严密对合;PASA异常的患者可在第1跖骨近端截骨面的背侧做一个基底在内侧的楔形截骨;根据患者的母外翻具体情况，将截骨远端向外侧推移不多于5 mm，用直径1.5 mm的克氏针或螺钉固定截骨块，去除第1跖骨截骨近端