作　　者： (冯仕明）; (王爱国）; (张在轶）; (丁朋）; (程建）;

机构地区： 江苏省徐州市中心医院手足显微外科,221009

出　　处： 《中华解剖与临床杂志》 2017年第4期296-300,共5页

摘　　要： 目的 探讨改良Coughlin截骨术治疗Ⅲ型小趾囊炎的临床效果. 方法 回顾性分析2013年3月-2015年4月徐州市中心医院手足显微外科收治的22例31足Ⅲ型小趾囊炎患者的临床资料,其中男3例3足,女19例28足;年龄26-78岁,平均45.3岁.患者均采用改良Coughlin截骨术治疗,术后观察骨折愈合情况,评测第四五跖骨间夹角、小趾内翻角、第五跖骨外翻角变化、患者足部疼痛缓解及对足部外观满意等情况,并采用美国足踝外科协会小趾-跖趾-趾间关节评分系统（AOFAS）对手术治疗效果进行评价.结果 本组患者均顺利完成手术,术后所有创口均获一期愈合,未出现感染或者皮肤坏死等并发症.术后22例31足获得随访,时间6-30个月,平均17.8个月.患者术后骨折愈合时间为6-14周,平均11.6周.末次随访时,患者创口外观理想,足趾外观无畸形,未出现转移性跖骨痛以及胼胝复发.末次随访时,第四、五跖骨间夹角为5.9°±1.6°,小趾内翻角为6.1°±2.3°,第五跖骨外翻角为2.2°±1.2°,均比术前的16.3°±5.1°、10.7°±3.5°、5.8°±2.6°明显减小,差异均有统计学意义（t=10.833、6.115、7.000,P值均〈0.01）;AOFAS评分为（89.0±8.4）分,比术前（60.2±9.3）分明显增高,差异有统计学意义（t=12.795, P〈0.01）.结论 改良Coughlin截骨术具有操作简便,手术创伤小,效果显著等优点,是治疗Ⅲ型小趾囊炎一种有效的方法. Objective To explore the surgical method of the modified Coughlin osteotomy for surgical treatment of Ⅲ type tailor＇s bunion and report the clinical outcomes.Methods The data of 22 patients （31 feet） with Ⅲ type tailor＇s bunion deformity who were hospitalized for treatment in Xuzhou Central Hospital from March 2013 to April 2015 were retrospectively analyzed.There were 3 males （3 feet） and 19 females （28 feet）, aged 26-78（mean 45.3） years old.The modified coughlin osteotomy was used for surgical treatment.Main postoperatively outcome measures included fracture healing, 4-5 intermetatarsal angle, the fifth metatarsophalangeal angle, lateral deviation of the fifth metatarsal angle, pain and appearance.Patients were scored using the American Orthopaedic Foot and Ankle Society （AOFAS） lesser toe metatarsophalangeal-interphalangeal scale.Results All operations were performed with no complications.Primarily healing of the wound was achieved in all cases.All the patients were followed up for a mean time of 17.8 months （range from 6 to 30 months）.The mean fracture healing time was 11.6 weeks （range, 6 to 14 weeks）.All the patients had satisfactory appearance and sensory function without callosum and metastatic metatarsalgia at the final follow-up.At the final follow-up, the average 4-5 intermetatarsal angle, fifth metatarsophalangeal angle and lateral deviation of the fifth metatarsal angle were 5.9°±1.6°, 6.1°±2.3° and 2.2°±1.2°, respectively, and were less than those of preoperatively angles of 16.3°±5.1°, 10.7°±3.5°, 5.8°±2.6°, respectively, with statistically significant difference（t=10.833, 6.115, 7.000, all P values〈0.01）;the mean AOFAS score was 89.0±8.4,which was more than that of preoperatively value of 60.2±9.3 with statistically significant difference （t=12.795, P〈0.01）.Conclusions The modified coughlin osteotomy is a safe and easy treatment option for the Ⅲ type tailor＇s bunion deformity and provides patient satisfaction results.

关 键 词： 滑囊炎 裁缝师 截骨术 截骨 修复外科手术