【摘要】 目的分析改良Lapidus手术治疗拇外翻的疗效,并总结手术经验。方法自2004年4月～2008年4月,采用改良Lapidus方法治疗拇外翻患者16例21足,平均年龄54岁。术前症状为第1跖骨内侧拇囊突起疼痛,第2跖骨头下痛性胼胝,中足足背偏内侧疼痛。患者术前应力位摄X线片显示第1、2跖骨间角(IMA)平均17.4°(15.3～22.3°),拇外翻角(HVA)平均38.5°(32.2～50.4°),8侧足有第1跖楔关节骨关节炎表现。术前AOFAS评分平均46.7分。行改良Lapidus手术后,所有患者得到随访,平均随访17个月。结果术后所有患者都达到骨性愈合,均在术后3～4个月后完全负重。除1例患者术后2年复发第2跖底痛外,其余所有患者第1跖骨头内侧痛、第2跖底痛及足背痛症状消失,且无复发。术后IMA平均5.9°,HVA平均10.3°,术后AOFAS评分平均91.3分。结论 Lapidus方法纠正第1跖骨内收的中-重度拇外翻畸形,特别是伴有第1序列不稳或第1跖跗关节炎时非常有效。选择合适的患者,并在手术中注意操作细节,可避免并发症的发生。更多还原

【Abstract】 Objective To analyze the treatment of hallux valgus with modified Lapidus arthrodesis and introduce the experience of this procedure.Methods Twenty-one hallux valgus feet in 16 cases were treated by modified Lapidus procedure from April 2004 to April 2008.The mean age of the patients was 54 years old.The main complains of these patients were pain at the bunion,painful callus under the 2nd head of metatarsal bone,and pain at the dorsal and medial aspect of the middle foot.The mean IMA was 17.4°(15.3～22.3°),the mean HVA was 38.5°(32.2～50.4°).Arthritis of tarsometatarsal joints appeared in eight cases.The mean AOFAS score was 46.7.All the patients were followed up to evaluate this procedure.The mean time of follow up was 17 months.Results Bone union occurred in all cases.The symptoms disappeared in all the patients and didn’t recur except one case.The mean IMA was 5.9°,the mean HVA was 10.3° postoperatively and the mean AOFAS score after surgery was 91.3.Conclusion The modified Lapidus procedure is a powerful technique for correcting moderate to severe hallux valgus with metatarsus primus varus,especially with hypermobility of the first ray.更多还原