事件记录
面试官: So maybe you or a loved one has a bony protrusion on your 脚. It's maybe painful, maybe not. 这是拇外翻. 究竟如何治疗拇囊炎？从治疗方案中可以期待什么样的结果?
大发娱乐今天请来了. 德文郡尼克松. He is an orthopedic surgeon at University of Utah Health, with an emphasis on lower extremity, 脚, 还有脚踝药.
现在,博士. 尼克松，在大发娱乐开始治疗之前，让大发娱乐从最基本的开始. What is a bunion exactly?
Dr. 尼克松: 拇囊炎是一种很有趣的疾病大发娱乐在临床上很常见. 这不仅仅是在大脚趾内侧形成的肿块. 实际上发生的是一个复杂的三维变化，脚趾的一部分开始向里面移动, 然后将大脚趾部分推向第二和第三个脚趾. 它甚至可能开始在第二和第三个脚趾下面交叉.
面试官: And is there any way to, say, prevent them?
Dr. 尼克松: I wish there was a way to prevent them. 它们很常见，当然不是每个拇外翻患者都需要手术. 因此，有很多事情要做，以使他们更舒适, like modifying your shoes or adding a toe spacer. 但不幸的是, those options don't necessarily change the long-term progression, 哪一个 is that the bunion may slowly increase over time.
面试官: So let's go back a little bit with that. 当你谈到治疗时，你说不一定是手术. If we're not doing surgery, what are the other options available, and what are you actually treating with those?
Dr. 尼克松: Like most things in my practice and in most orthopedic practices, there are nonsurgical and surgical treatments. 许多患者选择的非手术方法是对他们的鞋子做一些修改. 所以他们把鞋做得更宽，以大发娱乐减少对大脚趾内侧的刺激, 哪一个, 对很多病人来说, is one of their biggest pain drivers.
另一件事是，他们可以在大脚趾和第二个脚趾之间添加非处方的凝胶插入物，大发娱乐把脚趾推远一点，让它更舒适.
And those are all driven based on symptoms. 所以是否进行手术的选择是由病人决定的. It's certainly not one that I will make for them. 我的目标是大发娱乐他们获得做出正确选择所需的信息.
但是在修改你的鞋子和添加插入物之后，没有太多的选择. 所以，不幸的是，谈话可能会转向，“我的手术选择是什么?“这些都有助于让脚趾变直，并大发娱乐去除肿块.
面试官: So let's move on to those surgical options. As an orthopedic surgeon, any time a patient hears the word "surgery," there's a little bit of anxiety. There's a little bit of weighing the risks and benefits. Kind of walk us through the surgery. 不一定是所有事情的具体细节，但作为一个病人，这是门诊手术吗? How long can I expect to recover, etc.?
Dr. 尼克松: 绝对. 我的意思是, 我是外科医生, 但我对没有人愿意做手术这个事实非常敏感. And my job will never be to sell anyone on the surgery. 病人来告诉我，他们认为这是对他们最好的选择. They feel like they've tried these other things.
手术的技术选择也因病人而异. So it's driven by a lot of factors, 有些是临床的, some of them on the X-ray, some of them very patient-specific.
但基本上，大发娱乐所做的是通过拉伸大脚趾来矫正拇囊炎. And you can do that by either cutting the bone and shifting it. We call that an osteotomy.
You can fuse certain joints around the big toe. So one of them is fusing a joint closer to the middle of the 脚, and we call that a Lapidus procedure.
And then another procedure is, depending on the patient, if they have some arthritis that's developed, you can fuse the actual big toe joint itself.
但是从外科的角度来看，很多决定对每个人来说都是不一样的. So that's a conversation that we all have in clinic. If patients feel like they're at a surgical level, 我看x光片, 我和他们交谈, 有良好的历史记录, understand their activity level, 他们的目标是什么？, and if there's any arthritis present, 然后大发娱乐讨论, "What are these varying treatment options?"
面试官: 像这样的手术，病人需要接受多长时间的治疗? How long does the procedure last and how long is recovery?
Dr. 尼克松: 是的. The surgery is an outpatient procedure. You go home the same day. 主要目标是 . . . Depending on 哪一个 type of surgery to do, 这并不能真正改变一个事实，在最初的4到6周, 大发娱乐要让你的脚远离你的大脚趾的全部重量.
如果大发娱乐要切开骨头，做大发娱乐所说的截骨术，大发娱乐需要骨头愈合. 如果大发娱乐想让关节融合，那么大发娱乐也需要这些骨头一起愈合. And so there is a form of protected weight-bearing, 如果是你的右脚，哪一个是具有挑战性的，因为它会限制你的驾驶.
But the first two weeks, you have sutures in. They get removed at two weeks. And then between Weeks 2 to 6, you're kind of protecting your 脚, and then usually get X-rays around the six-week mark. Depending on the type of surgery you had, 大发娱乐可能会开始提高你的负重，这样你就可以把更多的重量放在大脚趾上.
面试官: 那么，在这个特殊的过程中有很多物理治疗或其他相关的东西吗?
Dr. 尼克松: Physical therapy is certainly a very reasonable thing to consider. 对一些病人来说，他们认为这对他们有很大的大发娱乐. 其中一些取决于手术类型和外科医生的具体决策. Not all bunions need physical therapy afterwards, 但我做过手术的很多病人都从物理治疗中获益良多.
面试官: And what is the success rate for a procedure like this?
Dr. 尼克松: It depends a little bit on the operation you do. 如果你同时患有拇囊炎和关节炎大发娱乐要解决的问题之一就是, if you have the big toe joint fused, and if that goes on to fusion, 哪一个 can occur in about 90% or so of patients, then those are some of our happiest patients. 他们做得很好. They can remain very active.
融合术的缺点是它限制了大脚趾的活动. So getting back into high heels is challenging. Getting back into certain types of activities, like certain yoga poses, the toe just won't let you do that. 所以这是一个缺点，但它确实是一个非常强大和成功的操作.
If we are preserving the joint and we are cutting the bones, then patient satisfaction is usually in the 80% to 90% range. 病人 do quite well from those operations.
Whichever one you choose, they do require some level of recovery. And I would be lying to you if I said that it's a fast recovery. Some patients recover faster than others, but the first couple of weeks, there's going to be some swelling involved, so it's really important to keep it elevated. But as you begin to progress your recovery, 你会开始消肿，希望能很快适应正常的鞋子, 只要大发娱乐允许, once we get X-rays that confirm that everything has healed up well.
面试官: 作为一名外科医生，你会告诉那些想要做拇外翻手术的人什么给他们最后一点信心?
Dr. 尼克松: 我认为真正重要的是，所有的决定都是由病人做出的. 我的工作或者我的任何合作伙伴的工作就是确保你有正确的信息来做出决定.
And at the end of the day, 患者可以从拇外翻矫正中得到很多疼痛的缓解，很多满意度和很多改善, 哪一个ever method you choose.
And like most things in life and in medicine, they all have some form of a pro and con weighing, a pro and con assessment, but 哪一个ever one you choose, patients do quite well from these operations. 有一个恢复过程，但最终，病人做得很好.
