改良Chevron截骨治疗■外翻

Modified Chevron osteotomy for hallux valgus

目的探索Chevron截骨术治疗[足母]外翻的改良方式和术前设计方案。方法对35例(46足)[足母]外翻患者行改良Chevron截骨术,术前和末次随访时分别测量[足母]外翻角、1/2跖骨间夹角、1/2跖骨头间距离、第1跖骨长度。结果截骨均获得骨性愈合,1例患者复发,无切口感染、血管神经损伤、[足母]内翻、转移性跖骨痛等并发症发生。术后[足母]外翻角、1/2跖骨间夹角、1/2跖骨头间距离较术前明显减小,且术前、术后测量指标差异有统计学意义(P<0.05)。术后第1跖骨长度较术前平均短缩仅0.86mm,但是术前、术后跖骨长度差异有统计学意义(P<0.05)。结论改良Chevron截骨术依据背侧截骨面轴线角度、跖骨头外移距离与跖骨延长长度的三角函数关系,以患者具体情况为前提,确定跖骨目标长度后制定准确的截骨轴线角度和跖骨头外移距离,是一种较为理想的治疗方案。

Objective To explore the improved method and preoperative design of Chevron osteotomy for the treatment of hallux valgus.Methods Modified Chevron osteotomy was performed in 35 patients (46 feet) with hallux valgus.The angle of hallux valgus,1/2 intermetatarsal angle,1/2 metatarsal distance and metatarsal length were measured before operation and at the last follow-up.Results Bone healing was achieved in all osteotomies.One patient relapsed without complications such as wound infection,vascular nerve injury,hallux varus and metastatic metatarsal pain.The angle of hallux valgus,1/2 intermetatarsal angle,and the distance between 1/2 metatarsal bones were significantly improved postoperatively(P<0.05).The length of the first metatarsal bone after operation was only 0.86 mm shorter than that before operation,but there was significant difference in the length of metatarsal bone before and after operation (P<0.05).Conclusion The modified Chevron osteotomy is based on the trigonometric function of the angle of the dorsal osteotomy axis, the distance of the humeral head and the length of the tibia.Based on the specific conditions of the patient,it is an ideal treatment plan to determine the angle of the osteotomy axis and the distance of the metatarsal head after determining the target length of the metatarsal.