拇外翻_2课件

柴文华 女 71 入院时间：2009-12-1 主因：间断性右踇趾疼痛8年余入院 查体:外翻畸形 ,内侧突起,case report,Hallux valgus,Hallux valgus,X-ray Footwears Pain & inflammation Surgical indication: conservative measures are not effective Destination: Straighten the joint as much as possible and relieve pain How? Complicated!,weight-bearing dorsoplantar (DP) views of the foot,The hallux valgus angle First MTP joint congruence Interphalangeal angle First tarsometatarsal joint Proximal and distal articular set angles The rst intermetatarsal angle Medial Eminence Sesamoid Position,Hallux valgus angle,the severity of Hallux valgus deformity 15 A corrective soft-tissue procedure,Proximal Articular Set Angle,Cannot be evaluated clinically 10 Metatarsal bone itself Osteotomymetatarsal articular surface more medially,Distal articular set angle,Cannot be evaluated clinically 10 Proximal phalanx itself osteotomy of the proximal phalanx If not be recognized overcorrection,Hallux interphalangeus angle,10 Appear worse than it truly is. Recognizeosteotomy Overcorrection,First tarsometatarsal joint,no consistent normal value flat or curved with varying degrees of medial inclination clinically:increase in the range of motion of the first metatarsal.,joint arthrodesis not replacement or resection arthroplasty,Increased medial inclination a curved articulation advanced arthrosis hypermobility,First intermetatarsal angle,12 Clinical palpation Metatarsal osteotomy to orientate the distal aspect of the first metatarsal bone more laterally as increased,more proximally to allow for greater lateral angulation,severe cases,First MTP joint congruence,cannot assess clinically exposed metatarsal head atricular cartilage soft-tussue procedure+osteotomy(eroded cartilage),First Metatarso-Phalangeal joint arthrosis,the pain remains if the arthrosis severe and the motion exsists arthrodesis (关节固定术)-stability,younger replacement or resection arthroplasty-,less load,old spurs shave,First Metatarso-Phalangeal joint arthrosis,Bone stock,osteopenic bone cystic changes,Medial Eminence Sesamoid Position,Conlusion,systematic evaluation for correct surgical procedure various sites of angular deformity Articulation bone stock,外翻角：29（15），半脱位 第一跖骨间夹角：19（14） 近端、远端关节面补偿角、趾骨间角未见异常 关节缘骨质增生，内侧见骨性突起 未见骨质疏松 籽骨及跗跖关节难以评估,手术记录,右足踇指内侧梭形切口，切除多余的梭形皮瓣，显露踇囊，见踇囊增生肥厚，并有一小的滑囊。 将踇囊做L型切开，显露第一跖骨头内侧面，见其增生明显，用骨刀平行屈肌间沟将增生的骨赘修去，骨蜡涂抹松质骨面。 松解第一跖骨头外的关节囊，将籽骨移于