踇外翻患者行改良Chevron截骨手术治疗的效果及其安全性

Effect and safety of modified Chevron osteotomy on patients with hallux valgus

目的观察踇外翻患者行改良Chevron截骨手术治疗的效果及其安全性。方法选择2015年4月-2017年4月在核工业四一六医院骨科接受治疗的88例踇外翻患者(96病足)作为研究对象,按随机数字表法分成观察组和对照组各48足。观察组患者行改良Chevron截骨手术予以治疗,对照组患者则行常规Chevron截骨手术予以治疗。观察比较2组患者的治疗效果、并发症以及治疗前后Maryland评分、X线指标[踇外翻角(HVA)、第1、2跖骨角(1～2IMA)、第1、2跖骨相对长度(MPD)]、跖骨头下区域峰压强的变化情况。结果治疗后,观察组的总有效率为93.8%,对照组为89.6%,2组比较差异无统计学意义(χ~2=0.546,P=0.460);2组患者的Maryland评分均较治疗前显著升高,并且观察组患者上升较对照组更为显著(t=4.033,=0.000);2组患者的HVA、1～2 IMA、MPD水平均较治疗前显著改善,并且观察组患者改善较对照组更为显著(t=2.328、3.615、2.107,P=0.011、0.000、0.019);在跖骨头下区域峰压强方面,2组患者的M1、M2、M3处均较治疗前显著改善,且观察组患者改善较对照组更为显著(t=4.189、2.238、5.673,P=0.000、0.014、0.000);2组患者均未发生较为明显的并发症。结论踇外翻患者行改良Chevron截骨手术治疗,能够获得良好的临床效果,显著改善患者的Maryland评分、X线指标以及跖骨头下区域峰压强,并且具有较高的安全性,值得推广应用。

Objective To investigate the effect and safety of modified Chevron osteotomy on patients with hallux valgus. Methods Eighty-eight cases（96 foot） of patients with hallux valgus were selected,who were treated in hospital from April 2015 to April 2017, and they were divided into the observation group（48 cases） and control group（48 cases）. The patients of control group were treated with conventional Chevron osteotomy. The patients of observation group were treated with modified Chevron osteotomy. Observe and compare the treatment effect, complications and the changes of Maryland score, X ray index（HVA,1-2 IMA, MPD）,metatarsal head area peak pressure levels of two groups. Results After the appropriate treatment, the patients of the observation group got a total effective rate of 93. 8%,the control group of 89. 6%, there was no statistically significant difference between two groups（χ^2=0.546, P= 0.460）. The Maryland score of the two groups were all significantly higher than before, and the patients of the observation group got more significant rose（t = 4. 033, P =0. 000）. The HVA, 1-2 IMA MPD levels of the two groups were all significantly improved than before, and the patients of the observation group got more significant improvement（t=2. 328,t=3.615, t =2. 107, P = 0. 011, P = 0. 000, P =0.019）. The metatarsal head area peak pressure of M1, M2, M3 of the two groups were all significantly improved than before,and the patients of the observation group got more significant improvement（t = 4. 189, t = 2. 238, t= 5. 673, P =0. 000,P = 0. 014,P = 0.000）. There were no more obvious complications occurred in both two groups. Conclusion Modified Chevron osteotomy in the treatment of patients with hallux valgus can achieve good clinical results, significantly improve the patient＇s Maryland score, X ray index and metatarsal head area peak pressure, and has a high safety, which makes it worthy of popularization and application.