骨科手术早知道007：拇囊炎切除/拇外翻矫正（BUNIONECTOMY /CHEVRON BUNIONECTOMY）
拇外翻畸形是指拇趾在第一跖趾关节处向外侧偏斜移位。拇囊炎是指在拇外翻畸形中出现的明显的内侧突起，但一般情况下这两个名词可互换使用。拇外翻是累及拇趾的最常见的病变，多见于中老年妇女，最常发生在有遗传倾向加上长时间穿不合适的鞋子的人，不合适的鞋子会对拇趾施加异常压力。拇外翻是一种复杂的解剖畸形，并且在治疗上极具挑战性。
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https://v.qq.com/txp/iframe/player.html?vid=n0326n3xcug&width=500&height=375&auto=0
Overview（概述）
This outpatient procedure is performed to correct a bunion, a deformity of the toe joint. During the procedure, the surgeon may remove excess bone and then shift the toe into proper alignment. This surgery is commonly performed with regional anesthesia.
本门诊手术用于矫正拇囊炎，这是一种脚趾关节的畸形。在术中，外科医生会去除额外的骨，然后将脚趾转位到合适的对线。手术通常在区域麻醉下进行。
Bunionectomy（拇囊炎切除）
In preparation for the procedure, the patient is positioned and anesthesia is administered. The surgeon creates an incision along the side of the toe to expose the bunion. The surgeon may remove a portion of this bone to eliminate the large bump. In most cases, this alone is not enough to correct the deformity. Commonly, the bones of the toe require realignment.
准备手术时，患者取合适体位，实施麻醉后，外科医生在脚趾侧方作一切口，以显露拇囊炎。医生会去除一部分骨头，以消除巨大的骨隆起。在大部分病例，单独这样做不足以矫正畸形。通常，脚趾头的骨头需要重新排列。
Osteotomy（截骨）
To correct the toe's alignment, the surgeon carefully cuts below the head of the first metatarsal. This allows the head of the bone to be repositioned. The surgeon may need to release tendons attached to the toe to eliminate the forces that are pulling the toe out of position.
为矫正脚趾的对线，外科医生小心地在第一跖骨头下切骨。这样跖骨头就可以重新定位。外科医生可能需要松解附着于脚趾的肌腱以消除将脚趾拉离位置的应力。
Realignment（重新排列）
The surgeon shifts the head of the first metatarsal to improve the alignment. The head of this bone is stabilized with screws, pins or other fixation devices.
外科医生将第一跖骨头转位以改善对线。第一跖骨头用螺钉、针或其它内固定装置固定。
End of Procedure and After Care（手术结束及术后护理）
When the procedure is complete, the surgeon closes the incision and bandages the foot. After a brief period of monitoring, the patient is allowed to go home. The patient will wear a walking cast, splint or surgical shoe for the next several weeks while the toe heals. The patient will be able to resume normal activities after six to eight weeks.
当手术完成后，外科医生关闭切口，将足用绷带包扎。在短时间的监护以后，病人被允许回家。在接下去的几周里，随着足趾的愈合，病人可能需要穿行走石膏、夹板或外科鞋。病人在术后6~8周可恢复正常活动。
(胡佰文 译）
附：BUNIONECTOMY WITH WEDGE OSTEOTOMY（楔形截骨拇囊炎切除术）
警告：请在有WIFI的场所观看视频，土豪请随意。
https://v.qq.com/txp/iframe/player.html?vid=f03265qk253&width=500&height=375&auto=0
Overview（概述）
This outpatient procedure is performed to correct a bunion, a deformity of the toe joint. This surgery is commonly performed with regional anesthesia.
本门诊手术用于矫正拇外翻，一种脚趾关节的畸形。本手术常在区域麻醉下进行。
Bunionectomy（拇囊炎切除）
In preparation for the procedure, the patient is positioned and anesthesia is administered. The surgeon creates an incision along the side of the toe to expose the bunion. Typically, the surgeon will trim away the bony bump. If a tendon is pulling the toe out of alignment, the surgeon may release it. In some cases, these modifications may be enough to correct the deformity. But in severe cases the bones of the toe require realignment.
准备手术时，将病人摆放合适体位并施行麻醉。外科医生沿脚趾的侧面作一切口，以显露拇囊炎。通常，外科医生会修剪骨赘。如果因肌腱牵拉使脚趾失去正常序列，外科医生会松解肌腱。在有些病例，这样修整就足以矫正畸形。但是在严重病例，脚趾骨头的序列需要重新排列。
Osteotomy（截骨术）
To correct the toe's alignment, the surgeon carefully removes a wedge of bone and then shifts the head of the first metatarsal to improve the alignment. The head of this bone is stabilized with screws, pins or other fixation devices.
为矫正脚趾的序列，外科医生小心地去除一块楔形的骨头，然后将第一跖骨头转动以改善序列，并用螺钉、钢针或其它内固定装置固定跖骨头。
End of Procedure and Aftercare（手术结束和术后护理）
When the procedure is complete, the surgeon closes the incision and bandages the foot. After a brief period of monitoring, the patient is allowed to go home. The patient will wear a walking cast, splint or surgical shoe for the next several weeks while the toe heals. The patient will be able to resume normal activities after six to eight weeks.
手术完成后，外科医生将切口关闭并用绷带包扎患足。在短暂的监护后，病人被允许回家。在接下去数周内，随着脚趾的愈合，病人需要穿行走石膏、夹板或外科鞋。大约6～8周后病人可恢复正常的活动。
（胡佰文 译）