骨科手术早知道108：拇外翻矫正术（Bunionectomy）
拇外翻是因关节不直造成大足趾内侧的骨头突出。拇外翻往往会引起疼痛并影响外观。拇外翻一般有遗传性，也就是说会在家族中代代相传，但会因鞋子的压迫而激发或恶化。拇囊炎切除术将拇囊炎切除并矫正关节位置，以缓解足痛。矫正拇外翻有许多手术方式，本动画介绍目前使用的最通用的技术。
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Bunionectomy (and First Metatarsal Osteotomy)
拇囊炎切除术（及第一跖骨截骨术）
Introduction（介绍)
A bunion is a bony bump, resulting from a misaligned joint, on the side of the big toe. A bunion is typically painful and may be unsightly. Bunions are primarily inherited, meaning they run in families, but may be irritated or made worse by pressure from shoes. A bunionectomy is a procedure that removes the bunion and realigns the joint to relieve foot pain. There are several techniques used to repair a bunion and this animation describes some of the more common techniques used today. Your physician can discuss details of your particular needs with you.
拇外翻是因关节不直造成大足趾内侧的骨头突出。拇外翻往往会引起疼痛并影响外观。拇外翻一般有遗传性，也就是说会在家族中代代相传，但会因鞋子的压迫而激发或恶化。拇囊炎切除术将拇囊炎切除并矫正关节位置，以缓解足痛。矫正拇外翻有许多手术方式，本动画介绍目前使用的最通用的技术。有关你的特殊需要，可以与你的医生详细商讨。
What is a Bunion（何谓拇外翻）
A bunion is a deformity of bone and soft tissue that occurs at the joint between the big toe, or hallux, and the first bone in the foot, called the first metatarsal. The point where these bones meet is called the metatarsophalangeal, or MTP, joint. A variety of foot structure abnormalities that typically involve tendons and ligaments around the joint may cause the big toe to be gradually pulled toward the second toe. The head of the first metatarsal bone sticks out, resulting in a bunion that worsens over time. The tendons or ligaments that pull on the toe incorrectly, may become overstretched and weak, or tight and thickened, and are often associated with swelling and pain. Additionally, a watertight sac surrounding the joint, called the bursa, typically becomes swollen, resulting in an even larger bump and increased tenderness.
拇外翻是大足趾（拇趾）和足内侧的第一骨（第一跖骨）之间的关节处发生的骨与软组织畸形。这两块骨头相接触的部位称为跖趾（MTP）关节。各种足部结构异常通常影响关节周围的肌腱和韧带，使大足趾逐渐靠近第二趾。第一跖骨头向外突出，引起拇外翻，随着时间推移而逐渐加重。异常牵拉足趾的肌腱或韧带，会过度伸长并乏力，或紧张变厚，常常相应地出现肿胀和疼痛。另外，关节周围水密性的囊，称为关节囊，往往变得肿胀，导致更大的包块和触痛加重。
Preparation（准备）
There are a variety of bunionectomy procedures, which generally include a combination of techniques to achieve the final result. Your physician will decide which procedure and options are best for you based on your specific condition. Bunionectomy procedures are typically performed in a hospital or outpatient center, where you will be permitted to go home the day of the surgery. You may be given general anesthesia, which allows you to sleep during the procedure, but more commonly, you will be given local anesthesia with IV sedation. In this case your foot will be numb and you will be relaxed but not entirely asleep.
拇外翻矫正术有很多方法，通常为了达到最终目的而联合采用几种技术。医生会根据你特殊的病情而决定最好的手术方案。拇外翻矫正术往往在医院或门诊中心进行，手术当天即可回家。医生可能会对你实施全麻，这样术中你可以安心睡觉。但更常见的是局部麻醉联合静脉使用镇静药。这时，你的脚是麻木的，你也会比较放松，但并不是完全睡着。
Procedure（手术）
Your surgeon will make an incision on the top of your big toe or on the side of your foot to expose the MTP joint. The bump is removed first and will only correct the deformity temporarily if it is not combined with other repairs. Typically, a small wedge of bone is also removed from the first metatarsal (first metatarsal osteotomy) in order to realign the joint. The bone is held in its new position with screws, pins, or plates. Additionally, loose tendons or ligaments often need to be shortened, or tight tendons or ligaments need to be lengthened, by cutting and repositioning them. For those who have had previous bunion surgery, any damaged portion of the joint may need to be removed. Once all repairs and adjustments have been made, the incision will be closed with sutures and a bandage will be wrapped around your foot.
手术医生会在你的大脚趾或足内侧作切口，显露跖趾关节。首先去除骨性突起，如果不联合其它修复手术，这只能暂时矫正畸形。通常，在第一跖骨截除一小块楔形骨块（第一跖骨截骨术），以使关节重新对位。用螺钉、钢针或钢板将骨头固定于新的位置。另外，通过切断或改变附着点，对松弛的肌腱或韧带进行短缩，而紧张的肌腱和韧带进行延长。对于那些曾经做过拇外翻手术的，需要切除已经受损的一部分关节。当所有的修补和调整完成后，缝合关闭切口，用绷带包扎患足。
Recovery and Results（恢复和结果）
Following the procedure, you can expect to have some pain, and swelling, and will likely be advised to keep your foot elevated for a few days to reduce swelling. Depending on the type of procedure, you may need to use crutches for one to two weeks to avoid bearing weight on your foot. Sutures are typically removed in about
two weeks, and any non-permanent screws or pins will be removed at variable times, depending on the type of procedure performed. You may be required to wear a surgical boot or shoe for several weeks to provide support for your foot as it heals, and your physician may recommend foot and toe exercises to keep your toe from becoming stiff. Your physician will advise you about when you may resume other activities.
术后，你可能会有一些疼痛和肿胀。医生往往会建议你在几天内抬高患足以减轻肿胀。根据手术的类型，你可能需要使用1～2周拐杖，避免患肢负重。一般2周左右可拆除缝线。在适当的时候将非永久性的螺钉或钢针除出，这取决于所做手术的类型。在愈合过程中，数周内可能需要穿外科靴或鞋，以保护患脚。你的医生可能会建议你做足和足趾的练习，以避免发生足趾关节僵硬。医生还会对何时恢复其他的活动提出建议。
Since bunions result from inherited foot anatomy, bunion surgery does not correct the cause of the deformity, but it does realign the toe, providing a remedy for the painful symptoms. A bunionectomy provides complete or nearly complete pain relief for most patients and improves the appearance of the foot indefinitely.
因为拇外翻是足解剖的遗传病变，拇外翻手术不能去除造成畸形的原因，但它对足趾进行重新对位，为疼痛症状提供了补救。大多数病人通过拇外翻矫正术使疼痛得到完全或近乎完全地解除，脚的外观也得到了长久地改善。
QUESTIONS FOR YOUR DOCTOR
1. What guidelines should I follow prior to my procedure? Will I need other tests or evaluations before the procedure?
在手术之前应遵循哪些指南？术前需要其它检查和评估吗？
2. Which type of repair will you perform and why is it the appropriate procedure for my condition?
医生将用哪种修复方法，为什么这种手术适合我的情况。
3. What will happen if I don’t undergo the procedure now?
如果现在不手术会有什么影响？
4. How long will the procedure last and will I be under anesthesia?
手术和麻醉需要多久？
5. Will I have dressings, bandages, or stitches after surgery? When should they be removed?
术后需要缝合、包扎？什么时候换药、折线？
6. How long of a recovery period can I expect, and what kind of help will I need during my recovery? Are there special instructions for eating, sleeping, or bathing?
术后恢复需要多久？恢复期间需要什么样的帮助？吃饭、睡觉、洗浴等有什么特殊讲究吗？
7. When can I return to work, resume normal activity, drive, and exercise?
我什么时候可以上班、恢复正常的活动、开车及锻炼？
8.Will I need crutches or walking assistance after the procedure, and for how long?
术后我是否需要使用拐杖或助行器？用多久？
9. Will I need to come back for appointments after the surgery?
术后是否需要复诊？
10. Will I have scars? Are the results permanent?
会留下疤痕吗？结果是持久的吗？
（胡佰文 译）
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