改良Chevron截骨结合远端软组织重建术对严重小趾囊炎的疗效

Modified Chevron osteotomy combined distal soft tissue reconstruction to treat high-grade bunionette deformity

目的探讨改良Chevron截骨结合远端软组织重建术对严重小趾囊炎的疗效。方法2013年6月至2015年6月，徐州市中心医院手足显微外科采用改良Chevron截骨结合远端软组织重建术治疗严重小趾囊炎26例（28趾），其中男3例（3趾），女23例（25趾）；年龄22～73岁，平均47.1岁。观察分析患者手术前后第四、五跖骨间夹角和第五跖骨外翻角、小趾内翻角的变化，采用美国足与踝关节协会（AOFAS）前足评分系统对治疗效果进行评价。结果26例患者均获随访，随访时间8～25个月，平均15.7个月。所有切口均获得一期愈合，截骨愈合时间6～15周，平均12.2周，无不愈合及延迟愈合。末次随访时，足趾外观无畸形，未出现转移性跖骨痛及胼胝体复发。术后6周第四、五跖骨间夹角、第五跖骨外翻角、小趾内翻角均显著小于术前[（5.5±1.7）°、（2.1±0.8）°、（5.7±2.6）°比（16.4±4.2）°、（6.0±2.2）°、（10.5±7.4）°，均P〈0.01]。术后AOFAS前足评分显著大于术前[（87.1±6.7）比（62.3±9.8）分，P〈0.001]。结论改良Chevron截骨结合远端软组织重建术对严重小趾囊炎有较好的疗效。

Objective To explore the surgical method of using the modified chevron osteotomy combined distal soft tissue reconstruction to treat high-grade bunionette deformity. Methods From June 2013 to June 2015, the modified chevron osteotomy combined distal soft tissue reconstruction was used for surgical treatment of high-grade bunionette deformity in the Department of Hand and Foot Microsurgery in Xuzhou Central Hospital. Twenty-six patients with 28 feet high-grade bunionette deformity were hospitalized for treatment, with 3 male （ 3 feet ） and 23 female （ 25 feet ） cases, aged 22 - 73 （ mean 47. 1 ） years old. The average fourth-fifth intermetatarsal angle, lateral deviation of the fifth metatarsal angle and metatarsophalangeal-fifth angle were measured on the pre-and post- operative anterior to posterior weight- beating X rays of treated feet. The American Orthopaedic Foot and Ankle Society （ AOFAS ） Lesser Toe Metatarsophalangeal-Interphalangeal Scale was used to evaluate the post-operative outcomes. Results All of 26 patients were followed, with a mean 15.7 months （range 8 -25 months）. Primarily healing of the wound was achieved in all cases. No postoperative infection and nonunion on the osteotomy site was found during the follow-up time. The fracture healing time was 6 - 15 （ mean 12. 2 ） weeks. All the patients had satisfactory appearance and sensory function without callosum and metastatic metatarsalgia at the final follow-up. The post-operative fourth-fifth intermetatarsal angle, lateral deviation of the fifth metatarsal angle and metatarsophalangeal-fifth angle were significantly lesser than the pre-operative at the 6th week after operation, respectively [（5.5±1.7）°、（2.1±0.8）°、（5.7±2.6）°,（16.4±4.2）°、（6.0±2.2）°、（10.5±7.4）°; all P 〈 0. 01 ]. The post-operative AOFAS score was significantly greater than the preoperative [ （87. 1 ± 6. 7 ） vs （ 62.3 ± 9.8 ） points, P 〈 0. 001 ] . Conclusion The modified chevron osteotomy combined distal soft tissue reconstruction is a safe and easy treatment option for the high-grade bunionette deformity and provides patient satisfaction results.