臨床整形外科53巻9号

2018年09月発行

誌上シンポジウム 外反母趾の成績不良例から学ぶ

外反母趾における胼胝の評価と中足痛と相関する足長軸方向の指標

著者： 中川悟¹ 中川晃¹ 中川剛² 福士純一³

所属機関： ¹中川整形外科 ²地域医療機能推進機構九州病院整形外科 ³九州大学病院整形外科

ページ範囲：P.779 - P.789

背景：中足痛(外反母趾における足底胼胝の痛み)は外反母趾に合併し，術後も重要な合併症である．本研究の目的は，第1中足骨の第2中足骨に対する相対的長さが小趾列底側の胼胝，中足痛の主因であることを証明することである．

方法：対象は二平面骨切り術を施行し，臨床所見とX線を備えた102足で，平均経過観察期間は16カ月であった．臨床評価はJSSF hallux scaleで行われ，X線学的評価は立位X線像から外反母趾角(HVA)，中足骨間角(IMA)を計測し，第1中足骨突出度(relative first metatarsal length：RML)はNilsonne/Mortonの計測法で行った．

結果：外反母趾角は術前平均37°から術後3°，中足骨間角は術前平均17°から術後4°に改善した．JSSF hallux scaleは術前平均56点から術後96点に改善した．足底胼胝の面積は術前平均3.1mm²から1.5mm²に改善した．術後中足痛の60％，無痛性胼胝の85％が改善した．X線指標の中でRMLはJSSF hallux scale(P＜.0001)と術後の中足骨痛(P＜.0001)と最も強く相関していた．

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