第06章 Austin手术治疗轻中度青少年拇外翻.doc

Austin手术治疗轻中度青少年外翻 胡令东， 郑建森， 李文勤， 张军 ，李吉忠 (山东省泰安荣军医院骨科足踝外科，山东 271000) 摘要 目的 探讨Austin手术治疗轻中度青少年外翻的疗效。方法 2005年11月至2008 年1月，采用Austin手术治疗轻中度青少年外翻病人16例，28足，年龄17~19岁，平均17.8岁，术前、术后十二个月及术后十五个月后时摄负重位X线片，测量外翻角(HVA), 近端关节固定角(PASA), 远端关节固定角（DASA），第一、二跖骨间角（IMA），术前、术后各组数据采用t检验进行统计学处理分析。结果 16例28 足全部得到随访，最短随访到术后15个月，最长的一例随访到术后27个月，平均随访时间16.9个月，外翻角较术前改善14.6度，第一跖骨间角较术前改善6.9度，近端关节固定角较术前改善8.3度（P值均小于0.05 ）；根据顾湘杰等的评价标准，患者主观评价：优19例，良8例，可1例，优良率96.4% 。 结论 Austin手术具有良好的截骨稳定性，手术方法简单，易于掌握推广，并发症少，疗效可靠，是治疗轻中度青少年外翻的理想术式。 关键词 外翻 跖骨 截骨术 Effects of Austin surgery for mild and moderate juvenile hallux valgus Hu Ling-dong, Zheng Jian-shen , Li Wen-qin et al. Department of Orthopaedics Taian Disabled-soldiers Hospital, Taian, Shandong Abstract [Objective] To evaluate the effects of Austin surgery for mild and moderate juvenile hallux valgus . [Methods ]From September 2005 to Januuary 2007 , 16 juvenile hallux valgus patients ( 28 feet )with average of 17.8 years ( range , 17 to 19 years )were treated with Austin surgery . The X-ray films of all patients were obtained before operation , and twelve months , fifteen months after operation . The hallus valgus angle ,intermetatarsal angle , proximal articular set angle , and distal articular set angle were measured and analyzed on radiographs . The surgical outcome was evaluated combined with the Gu Xiang-jie,s score . All pamameters were statistically analyzed . [Results] All the patients were completely followed up . Hallax valgus angle reduced from 26.3±1.19 to 11.7±0.40 , intermetatarsal angle reduced from 14.1±0.82 to 7.2±0.85, proximal articular set angle from 12.7±0.28 to 6.4±0.54 ( all P 0.05 ) .Based on Gu Xiangjie’ score , the subjective assessments were given as excellent in 19 feet , good in 8 feet ,and fair in 1 foot .The excellent to good result was 96.4% .[Conclusion] Stabilization can obtained after the first metatarsus osteotomy . Austin surgery is an ideal choice for mild to moderate juvenile hallux valgus