采用改良Chevron截骨联合外侧软组织松解治疗重度拇外翻的疗效观察

Preliminary radiographic and clinical results of severe hallux valgus treated by lateral soft tissue release with modified Chevron osteotomy

目的观察采用改良Chevron截骨联合外侧软组织松解治疗重度拇外翻的临床疗效。方法回顾分析2018年3月至2019年4月北京积水潭医院院足踝外科应用改良Chevron截骨联合外侧软组织松解的以拇外翻角(HVA)增大为主的重度拇外翻患者22例(27足),对照组患者42例(50足)。影像学检查包括HVA、第1、2跖骨轴线夹角(IMA)、第1跖骨轴线的垂线与第1跖骨头远端关节面的夹角(DMAA)、籽骨位置的术前影像及术后末次随访影像。临床结果基于术前及末次随访的美国足踝外科协会前足评分(AOFAS-Forefoot)、足功能指数调查表(FFI)、疼痛视觉模拟评分(VAS)项评分,患者满意度及术后并发症情况,对比两组患者的临床及影像学结果情况。结果两组患者的年龄、性别及随访时间差异无统计学意义(P>0.05)。两组患者术前的AOFAS,IMA差异无统计学意义。两组患者术前VAS评分、HVA、DMAA、术前籽骨位置差异有统计学意义(P=0.000)。较之对照组,重度组的VAS评分更低,但是HVA、DMAA及术前籽骨位置评分更大。两组患者随访(15.63±1.49)个月,术后末次随访两组患者组内的术前术后对比AOFAS、FFI、IMA、HVA、DMAA、籽骨位置差异均有统计学意义(P=0.00)。术后两组患者临床及影像学结果对比差异无统计学意义。以大于4分为满意标准,两组患者的术后满意度均较高(对照组87.7%,重度组95.9%),两组间差异无统计学意义。两组患者的术后并发症情况比较差异无统计学意义。结论对于以HVA增大为主的重度拇外翻患者,应用改良Chevron截骨联合外侧软组织松解的近期影像学及临床效果均非常满意。改良Chevron截骨联合外侧软组织松解可以作为以HVA增大为主的重度拇外翻患者纠正畸形的有效且可靠的手术选择。

Objective To assess radiographic and clinical outcomes of severe hallux valgus treated by lateral distal soft tissue release with modified Chevron osteotomy.Methods From March 2018 to April 2019,a retrospective analysis was performed to compare the utility of lateral soft tissue release with modified Chevron osteotomy for the treatment of 22 patients(27 feet)with severe hallux valgus mainly with enlarged hallux valgus angle(HVA)and 42 patients(50 feet)in the control group in Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital.The radiologic outcomes were evaluated based on preoperative images and last follow-up images,including HVA,IMA,DMAA,and sesamoid position.The clinical results investigated based on the before operation and the last follow-up scores of AOFAS,FFI,VAS,patient satisfaction and postoperative complications.Results There was no statistical difference in general age,gender and follow-up time between the two groups of patients(P>0.05).There was no statistical difference in the preoperative AOFAS and IMA between the two groups.The preoperative VAS scores,HVA,DMAA,and HVA of the two groups were not statistically different.The preoperative sesamoid position(P=0.000)was statistically different.Compared with the control group,the severe group had a lower VAS score,but the HVA,DMAA and preoperative sesamoid position scores were higher.The two groups of patients were followed up for(15.63±1.49)months.The preoperative and postoperative comparisons of AOFAS,FFI,IMA,HVA,DMAA and sesamoid position of the two groups in the last follow-up were statistically significant(P=0.00).There was no significant difference in clinical and radiologic results between the two groups of patients after operation.In satisfaction analysis,87.7%of the control group reported good to excellent results,as did 95.9%of the severe group(P=0.64).There was no statistical difference in postoperative complications between the two groups.Conclusions The short-term radiologic and clinical results of patients with severe hallux valgus with increased HVA(HVA greater than 40°,IMA less than 17°)treated by lateral soft tissue release with modified Chevron osteotomy were favorable.The lateral soft tissue release with modified Chevron osteotomy could be an efficient and reliable operative option for severe hallux valgus with increased HVA.