目的：探讨第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻的临床疗效。方法对12例重度拇外翻畸形患者(14足)采用第1跖趾关节融合结合Weil截骨或关节成形术治疗。结果患者均获得随访,时间6~44个月。术后患足外形均得到良好改善,13足拇外翻疼痛及跖痛消失,第2~5跖骨头下顽固性角化症、硬性胼底消失；1足出现第5跖骨外侧转移性跖痛,经垫前足减压垫缓解。术后患者跖趾关节有不同程度僵硬,经主、被动关节锻炼后,足趾活动度均有改善,未影响日常活动,患者步态及穿鞋要求均获得明显改善。末次随访时,患足AOFAS评分85.48分±2．97分,VAS评分2．41分±0．47分,HVA 14．93°±5．35°,IMA 9．68°±1．87°,各项指标均较术前明显改善(P<0．01)。结论采用第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻畸形,能明显改善前足外形,缓解前足行走疼痛,改善肢体功能,提高患者生活质量。%Objective To investigate the efficacy of the first metatarsophalangeal joint fusion combined with Weil′s osteotomy or arthroplasty to treat severe pollex valgus. Methods A total of 14 feet in 12 patients with severe pollex valgus of anterior foot were performed metatarsophalangeal joint fusion combined with Weil′s osteotomy or arthroplas-ty. Results All patients were followed up for 6~44 months. After operation, feet of patients were well improved, pain and pedionalgia of 13 feet with pollex valgus disappeared completely, refractory keratosis and rigid callus below 2~5 caput ossis metatarsalis disappeared. One foot had mestatic pedionalgia on lateral side of fifth metatarsus, which was relieved by decompressing pad under anterior foot. Metatarsophalangeal joints were rigid to varied degrees after operation. Ranges of motion for toes were improved after active and passive exercises of joints, daily activities were not affected, patient gait and shoe demand were significantly improved after operation. At the last follow-up, AOFAS score (85. 48 ± 2. 97) points, VAS (2. 41 ± 0. 47) points, HVA 14. 93° ± 5. 35° and IMA 9. 68° ± 1. 87° were obvi-ously improved than those before operation(P<0. 01). Conclusions The first metatarsophalangeal joint fusion com-bined with Weil′s osteotomy or arthroplasty can significantly improve appearance of anterior foot, alleviate walking pain of anterior foot, improve functions of limbs and quality of life for patients.
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