The clinical efficacy of treatment on the cases of severe hallux valgus by the first metatarsal basal osteotomy combined with Chevron-Gerbert operation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of treatment on the cases of severe hallux valgus by the first metatarsal basal osteotomy combined with Chevron-Gerbert operation.</p><p><b>METHODS</b>From June 2004 to August 2008, 37 cases of severe hallux valgus (66 feet) underwent first metatarsal basal osteotomy combined with Chevron-Gerbert operation. There were 5 males (10 feet) and 21 females (38 feet), aged 21 - 76 years (mean 58 years). For all patients with follow-up, radiographic measurements of frontal and lateral position of foot were taken to measure the hallux valgus angle (HVA), the IMA (intermetatarsal angle) and the proximal articular set angle (PASA) preoperatively, postoperatively and in follow-up respectively. The measuring results were compared among the preoperative, the 6-week postoperative and the final follow-up. At the same time the patients were evaluated with the AOFAS Maryland score.</p><p><b>RESULTS</b>Of the original 37 patients, 26 patients (48 feet) were followed up. The mean durations of follow-up was 2.3 years (range from 1 to 4 years). At final follow-up, HVA corrected 25.6° ± 3.8°, IMA corrected 8.6° ± 2.4°, and PASA corrected 4.7° ± 4.2°. According to AOFAS rating system, 91.7% patients were rated as excellent or good with excellent in 15 patients (28 feet), good in 8 patients (16 feet), and fair in 3 patients (4 feet).</p><p><b>CONCLUSIONS</b>First metatarsal basal osteotomy combined with Chevron-Gerbert operation has good efficacy to the patients with severe hallux valgus. However there are disadvantages such as complexity relatively for multi-stage osteotomy and internal fixation.</p>

The vola stress change of patients after operation of wrop-around flap for thumb reconstruction / 中国骨伤

<p><b>OBJECTIVE</b>To analyse the vola stress change after operation of wrop-around flap for thumb reconstruction,to know the influence of vola pressure change after operation of wrop-around flap.</p><p><b>METHODS</b>From 1996 to 2004, 23 patients after the operation of wrop-around flap for thumb reconstruction were measured the entire footprint, the vola stress of single foot and double feet on static state and walking status. There were 16 males and 7 females,with a mean age of 23.7 years (17 to 42 years). The time from operation to measuring was 1.6 to 6 years (meana 3.8 years). The results of measuring were analyzed.</p><p><b>RESULTS</b>Whether static footprint analysis or dynamic mechanical analysis, the plantar pressure distribution of donated foot were obviously different with those of the opposite site. The weight bearing of heel and the fourth and fifth metatarsal heads were nearly consistent with normal foot. But the former feet were obviously different. The weight bearing of the first metatarsal head was obviously lower than normal foot. And the weight bearing of the second and third metatarsal heads were obviously higher than normal foot.</p><p><b>CONCLUSION</b>The operation of wrop-around flap for thumb reconstruction has advantage of the cosmesis and function of the reconstructed thumbs nearly consistent with normal thumbs. But the operation influences the postoperative foot pressure.</p>