跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻

The clinical effect of distal metatarsal Chevron osteotomy and joint capsule release in the treatment of mild or moderate hallux valgus

目的探讨跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻的临床效果。方法对32例患者(48足)行Chevron截骨手术治疗,测量手术前后拇趾外翻角(HVA),第1、2跖骨间夹角(IMA)的变化,评估足部疼痛及关节活动恢复情况。结果 29例(44足)获得随访,时间12~16(14.5±4.1)个月;3例(4足)失访。患者对术后临床效果满意,截骨部位愈合时间为4~6周。术前HVA为30°±4.1°、IMA为14°±1.7°;术后3个月HVA为4°±4.2°、IMA为10°±2.4°,术后1年HVA为5°±4.5°、IMA为11°±3.3°,均较术前明显减小,差异有统计学意义(P<0.05);术后1年与术后3个月的HVA、IMA比较差异无统计学意义(P>0.05)。结论跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻疗效满意。

Objective To investigate the clinical effect of distal metatarsal Chevron osteotomy and release of joint capsule through medical approach in the treatment of mild or moderate hallux valgus. Methods Thirty-two patients （48 feet） with mild or moderate hallux valgus deformity were treated by modified Chevron osteotomy. The value of hallux valgus angle （HVA） and inter-metatarsus angle （IMA） ,the feet pain and joint movement before and after sur-gery were compared. Results The 29 patients were followed up for 12 ？16（ 14. 5 ±4. 1） months, 3 cases（4 feet） were lost. The patients were satisfied with the postoperative clinical results and the osteotomy positions were healed in 4 ？6 weeks. The preoperative HVA and IMA were 30.±4. 1., 14° ± 1 .7.,respectively; and which were 4° ±4. 2.,10o ±2. 40 at 3 months postoperation; 50 ±4. 50, 110 ±3. 30 at 1 year after operation,they were less than the preop-eration, the difference was statistically significant （ P 〈 0. 05 ） ; there were not statistically significant between the data of postoperative 3 months and 1 year （ P 〉 0. 05 ） . Conclusions Distal metatarsal Chevron osteotomy and transartic-ular lateral soft tissue release are effective methods for mild or moderate hallux valgus.