Deceptions in Hallux Valgus What to Look for to Limit Failures
Deceptions in Hallux Valgus What to Look for to Limit Failures
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DOI：
10.1016/j.fcl.2014.06.003
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发表时间：
2014-09-01
影响因子：
1.5
通讯作者：
Lee, Thomas H.
中科院分区：
文献类型：
--
作者：
Lee, Kyung Tai;Park, Young Uk;Lee, Thomas H.
拇外翻的治疗取决于多种因素，包括临床检查，患者考虑，临床表现，影像学评估和外科医生的偏好。适当的手术选择和适当的技术通常会导致良好到优秀的结果。然而，与任何手术一样，拇趾外翻矫正后也会出现并发症。这些并发症通常包括复发、转移性跖骨痛、缺血性坏死、拇内翻、跖骨截骨不愈合和畸形愈合，为了减少并发症的风险，术前应进行精确细致的体格检查，评估是否存在扁平外翻畸形、足跟索过紧、僵硬或可矫正的拇外翻、拇趾旋前、小脚趾鸡眼或老茧，第二跖趾关节滑膜炎、趾间神经瘤或第一跖跗关节活动过度，外科医生应选择适当的截骨术来矫正复杂的拇外翻畸形。“作为一个一般原则，畸形的严重程度决定了治疗方案。远端Chevron截骨术对轻度和中度拇外翻畸形的治疗效果是可预测的，对于更严重的畸形，多个第一跖骨近端手术联合远端软组织手术似乎可以提供满意的治疗。这些方法包括近端新月形、近端人字形、近端斜形（Ludloff）、近端闭合楔形、围巾截骨术和Lapidus手术。外科医生应坚持刚性骨原则来矫正复杂的拇外翻畸形。
The treatment of hallux valgus depends on multiple factors, including clinical examination, patient considerations, clinical findings, radiographic assessment, and surgeon preference.Appropriate procedure selection and proper technique will usually result in good-to-excellent outcomes. As with any procedure however, there are complications following hallux valgus correction. These commonly include recurrence, transfer metatarsalgia, avascular necrosis, hallux varus, and nonunion and malunion of metatarsal osteotomies.In order to decrease the risks of complication, a precise and meticulous physical examination should be conducted preoperatively, and it should assess for the presence of planovalgus deformity, tight heel cord, rigid or correctable hallux valgus, great toe pronation, corns or calluses of the lesser toes, second metatarsaophalangeal joint synovitis, interdigital neuromas, or first tarsometatarsal joint hypermobility.A surgeon should select appropriate osteotomies to correct complex hallux valgus deformities. " As a general principle, the severity of deformity dictates treatment options. A distal chevron osteotomy provides predictable outcomes for mild and select cases of moderate hallux valgus.For more severe deformities, multiple proximal first metatarsal procedures, combined with a distal soft tissue procedure, appear to provide satisfactory treatment. These include proximal crescentic, proximal chevron, proximal oblique (Ludloff), proximal closing wedge, scarf osteotomies, and the Lapidus procedure.A surgeon should adhere to rigid bone principles to correct complex hallux valgus deformities.