微创和开放Chevron截骨术治疗轻中度■外翻的疗效比较

Comparative effectiveness of minimally invasive Chevron and Akin osteotomy versus open Chevron osteotomy for mild-moderate hallux valgus

目的 比较第3代微创Chevron-Akin术(MICA)与开放Chevron术治疗轻中度■外翻(HV)的临床疗效。方法 2017年7月-2020年2月,46例(共52足)轻中度HV纳入本研究。24足采用MICA截骨术,其中16例联合Akin术;28足采用开放Chevron截骨术,其中12例联合Akin术。比较2组患者的并发症、临床评分及相关影像学参数。结果 2组患者均随访2年以上,微创组的平均手术时间、平均骨愈合时间均短于开放组(P<0.05)。微创组中有5例患者出现并发症,包括2例内固定刺激、1例关节僵硬及2例神经损伤,开放组中有9例患者出现并发症,包括6例关节僵硬、1例伤口开裂、2例瘢痕增生。2组总并发症发生率的差异无统计学意义(P>0.05)。2组患者术前的围术期资料、影像学参数及临床评估的差异均无统计学意义(P>0.05)。2组患者术后矫形效果稳定,临床评分及影像学参数比较差异无统计学意义(P>0.05)。结论 MICA与开放Chevron治疗轻中度HV均有良好的疗效,但MICA在缩短骨愈合时间和降低软组织并发症发生率方面更有优势。

Objective To compare the clinical effectiveness of the minimally invasive Chevron and Akin osteotomy(MICA)and open Chevron osteotomy for mild-moderate hallux valgus(HV).Methods A total of 46 patients(52 feet)with mild-moderate HV from July 2017 to February 2020 were enrolled,where 24 patients underwent MICA,including 16 combined Akin osteotomy,and 28 patients received open Chevron osteotomy,including 12 combined Akin osteotomy.Both groups were compared for complications,clinical scores,and radiographic parameters.Results All patients were followed for more than two years.The MICA group presented shorter operation time and average bone healing than the open group(P<0.05).Five patients in the MICA group reported complications,including two cases of fixation irritation,one case of joint stiffness and two cases of nerve injury.Meanwhile,nine patients in the open group reported complications,including six cases of joint stiffness,two cases of hypertrophic scars,and one case of wound dehiscence.There were no statistical differences in the incidence of complications between the two groups(P>0.05).No statistical differences were found in perioperative data,radiographic parameters,and clinical outcomes before surgery(P>0.05).The orthopedic effect were stable in the two groups and there were no statistical differences in clinical scores and radiographic parameters between the groups(P>0.05).Conclusions The MICA and open Chevron osteotomy is effective for mild-moderate HV,but MICA is advantageous in reducing soft tissue complications and shortening bone healing.