Chevron截骨术与Scarf截骨术治疗中度拇外翻的效果比较

Comparison of effects of Chevron osteotomy and Scarf osteotomy in the treatment of moderate hallux valgus

目的 比较Chevron截骨术与Scarf截骨术治疗中度拇外翻(HV)的效果,以为临床手术方式的选择提供参考。方法选取2016年8月至2019年1月我院收治的39例(60足)中度HV患者作为研究对象,根据手术方式不同将其分为Chevron截骨术组(19例,29足)和Scarf截骨术组(20例,31足)。分析两组切口愈合情况、并发症发生及处理情况;比较两组术前及末次随访时的美国足踝外科协会(AOFAS)、视觉模拟评分法(VAS)评分及拇外翻角(HVA)、跖骨间角(IMA)、跖骨远端关节角(DMAA)。结果 术后切口均Ⅰ期愈合,术后3足出现并发症,其中Chevron截骨术组1足出现HV复发,行翻修融合术;Scarf截骨术组1足为拇僵硬,通过加强第1跖趾关节锻炼后缓解;1足切口边缘皮肤感觉麻木,未作特殊处理,末次随访时症状已缓解。术前及末次随访时,两组的AOFAS、VAS评分比较,差异无统计学意义(P>0.05);末次随访时,两组的AOFAS评分均较术前升高,VAS评分均较术前降低,差异具有统计学意义(P<0.05)。术前及末次随访时,两组的HVA、IMA、DMAA比较,差异无统计学意义(P>0.05);末次随访时,两组的HVA、IMA、DMAA均较术前减小,差异具有统计学意义(P<0.05)。结论 Chevron截骨术与Scarf截骨术治疗中度HV的效果相当,可有效改善足功能及影像学表现。对于畸形较重的患者可联合第1趾骨近端基底Akin术,以纠正残留畸形。

Objective To compare the effects of Chevron osteotomy and Scarf osteotomy in the treatment of moderate hallux valgus(HV),so as to provide a reference for the selection of clinical surgical methods.Methods A total of 39patients(60 feet) with moderate HV admitted in our hospital from August 2016 to January 2019 were selected as the research objects.According to the different surgical methods,the patients were divided into Chevron osteotomy group(19cases,29 feet) and Scarf osteotomy group(20 cases,31 feet).The situation of incision healing,and the occurrence and treatment of complications of the two groups were analyzed;the American Orthopedic Foot and Ankle Society(AOFAS)and Visual Analogue Scale(VAS) scores,hallux valgus angle(HVA),intermetatarsal angle(IMA) and distal metatarsal articular angle(DMAA) were compared between the two groups before operation and at the last follow-up.Results All incisions healed in the stage Ⅰ,and complications occurred in 3 feet after operation.In the Chevron osteotomy group,one foot had HV recurrence and underwent revision fusion;in the Scarf osteotomy group,one foot was stiff thumb,which was relieved after strengthening the exercise of the first metatarsophalangeal joint;one foot skin feels numb at the edge of the incision,no special treatment was made,and the symptoms relieved at the last follow-up.There were no significant differences in AOFAS and VAS scores between the two groups before operation and at the last follow-up( P>0.05);at the last follow-up,the AOFAS score of both groups was higher than that before operation,the VAS score was lower than that before operation,and the differences were statistically significant( P 0.05);at the last follow-up,HVA,IMA and DMAA of the two groups were lower than those before operation,and the differences were statistically significant(P<0.05).Conclusion Chevron osteotomy is equivalent to Scarf osteotomy in the treatment of moderate HV,which can effectively improve foot function and imaging performance.For patients with severe deformity,Akin operation at the proximal base of the first phalanx can be combined to correct the residual deformity.