改良Chevron截骨术联合软组织松解术治疗中度外翻

Effect of modified Chevron metatarsal osteotomy combined with soft-tissue release on moderate hallux valgus

背景:随着对外翻认识的不断深入,有观点认为Chevron截骨术联合软组织松解术可通过重建籽骨的位置解决外翻畸形术后复发率高的问题,但尚无相关的临床研究。目的:评价外侧软组织松解术是否有助于提高第1跖骨远端Chevron截骨术对中度外翻的疗效。方法:回顾性分析2008年1月至2016年10月收治的中度外翻患者40例(46足),年龄39~67岁,根据手术方式分为Chevron截骨术不联合软组织松解术组(A组)24例26足和Chevron截骨术联合软组织松解术组(B组)16例20足,比较两组患者术前和末次随访时负重位X线片的第1、2跖间角(IMA)、外翻角(HVA),比较手术前、后的美国足踝外科协会评分(AOFAS),并进行患者满意度问卷调查。结果:40例(46足)全部获得随访,随访时间为19~31个月,平均(20.3±8.4)个月。A组和B组的术后HVA、IMA、PASA、DASA测量值均较术前获得明显提高(P<0.05),但A、B两组术后的HVA、IMA、PASA、DASA无统计学差异(P>0.05)。B组在内侧籽骨位置和患者满意度评分方面均优于A组。结论:采用第1跖骨远端Chevron截骨术联合软组织松解术对中度外翻畸形的矫正效果显著,同时可改善内侧籽骨位置,患者满意度高。

Background： Nowadays knowledge on hallux valgus is deepening more, some investigators hold that Chevron osteotomy combined with soft-tissue release procedure may solve the problem by repositioning sesamoid bone, but no such clinical researches are carried out. Objective： To explore the effectiveness of lateral soft-tissue release on hallux valgus in distal first metatarsal Chevron osteotomy. Methods： A total of 40 patients with moderate hallux valgus（46 feet） at the age ranging from 39-67 years old hospitalized from January 2008 to October 2016 were retrospectively analyzed, they were divided into two groups according to surgical procedures as only distal first metatarsal Chevron osteotomy group（group A, n=24, 26 feet） and distal first metatarsal Chevron osteotomy combined with lateral soft-tissue release group（group B, n=16, 20 feet）. The 1 stand 2 ndintermetatarsal angles（IMA） and hallux valgus angle（HVA） measured from weight-bearing X-ray films were compared between pre-operation and the final follow up in the two groups. The American Orthopedic Foot and Ankle Society＇s（AOFAS） scale was compared preoperatively and postoperatively, and the survey of patients＇ satisfaction was conducted. Results： All patients were followed up for an average of（20.3 ± 8.4） months（range, 19-31 months）. HVA,IMA, PASA and DASA obtained after operation were all improved compared with pre-operation（P〈0.05）, but there was no significant difference between the two groups after the operation（P〉0.05）. Patients in group B had better medial sesamoid bone position and patient satisfaction as compared with group A. Conclusions： The distal first metatarsal Chevron osteotomy combined with lateral soft-tissue release can provide a good correction outcome in the treatment of moderate hallux valgus, with medial sesamoid bone position improved and high patient satisfaction.