改良Chevron截骨术结合软组织松解术治疗中重度[足母]外翻的疗效分析

Efficacy of modified CChheevvrroo nn osteotomy combined with soft-tissue release on moderate to severe hallux valgus

背景:有研究认为改良Chevron截骨术结合软组织松解术可用于矫正中重度[足母]外翻,但该观点尚未形成广泛认同。目的:评估改良Chevron截骨术结合软组织松解术治疗中重度[足母]外翻的疗效和安全性。方法:回顾性分析2015年1月至2017年12月收治的采用改良Chevron截骨及周围软组织松解术治疗的中重度外翻患者20例,共27足。记录并比较术前与末次随访时[足母]外翻角(HVA)、第1、2跖骨间角(IMA)、跖骨远端关节角(DMAA)及前中足美国足踝外科协会(AOFAS)评分。结果:20例患者均获得随访,随访时间12~47个月,平均随访(22.4±8.2)个月。末次随访时患者HVA、IMA、DMAA均小于术前[(8.2±6.7)°vs(36.0±9.3)°、(5.2±1.7)°vs(15.2±2.0)°、(4.8±3.3)°vs(14.0±4.6)°],AOFAS评分高于术前[(89.4±8.5)分vs(51.9±10.0)分],且差异均有统计学意义(t=17.88、30.49、9.28、-13.12,P均<0.001)。末次随访时,2例患者(2足)出现内翻,但无明显症状,1例患者(1足)出现[足母]僵直,为唯一不满意病例,未发现转移性跖骨痛、第1跖骨头坏死、骨不连或骨髓炎等并发症。结论:改良Chevron截骨术结合软组织松解术能有效治疗中重度外翻,操作简便、创伤小、并发症少。改良Chevron截骨术可以通过延长跖侧截骨面,最大移位跖骨远端13 mm,有效矫正IMA为20°的[足母]外翻。

Background:Some studies suggested that modified Chevron osteotomy combined with soft-tissue release can be used to treat moderate to severe hallux valgus,but this view has not been widely accepted.Objective:To evaluate the clinical efficacy and safety of modified Chevron osteotomy and lateral release for correction of moderate to severe hallux valgus deformities.Methods:A retrospective analysis was made in 20 patients(27 feet)with hallux valgus treated by Chevron osteotomy combined with surrounding soft-tissue release from January 2015 to December 2017.The preoperative and final follow-up results of hallux valgus angle(HVA),intermetatarsal angle(IMA),distal metatarsal articular angle(DMAA)and AOFAS forefoot and middle foot score were compared.Results:The mean duration of follow-up in these patients was(22.4±8.2)months(range,12-47 months).The HVA,IMA,DMAA and AOFAS scored at the last follow-up were significantly different from those before operation(8.2°±6.7°vs 36.0°±9.3°,5.2°±1.7°vs 15.2°±2.0°,4.8°±3.3°vs 14.0°±4.6°,89.4±8.5 vs 51.9±10.0;t=17.88,30.49,9.28 and-13.12,P<0.001).At the last follow-up,hallux varus occurred in two patients(two feet),but there were no obvious symptoms.Hallux stiffness was found in one patient who was unsatisfactory for the treatment.No complications such as metastatic metatarsal pain,necrosis of the first metatarsal head,nonunion or osteomyelitis were found.Conclusions:Modified Chevron osteotomy combined with soft tissue release can effectively treat moderate to severe hallux valgus.It has the advantages of simple operation,less trauma and fewer complications.Modified Chevron osteotomy can effectively correct hallux valgus deformity with IMA of 20 degrees using a long plantar arm to displacing distal metatarsal maximum 10 mm.