微创与传统Chevron截骨治疗轻中度拇外翻的疗效比较

Comparison of minimally invasive and traditional Chevron osteotomy in treating patients with mild to moderate hallux valgus

目的:比较微创与传统Chevron截骨法治疗轻中度拇外翻的临床疗效。方法:回顾性分析2019年1月至2021年月2月收治的36例(36足)轻中度拇外翻患者的临床资料,按照手术方法不同分为微创截骨组(微创组)和传统Chevron截骨组(传统组)。微创组16例(16足),男1例,女15例,年龄36~60(49.0±9.5)岁;按照Mann分型标准,轻度9例,中度7例;采用微创截骨结合空心钉固定治疗。传统组20例(20足),男2例,女18例,年龄38~65(50.0±9.2)岁;按照Mann分型标准,轻度11例,中度9例;采用传统Chevron截骨治疗。观察并比较两组患者术前和术后12个月拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),比较术前、术后6周和12个月美国矫形足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)前足评分和视觉模拟评分(visual analogue scale,VAS)。结果:36例(36足)患者获得随访,时间14~30(21.00±5.77)个月。术后所有患者伤口Ⅰ期愈合,无感染。术前和术后12个月两组患者HVA、IMA、AOFAS前足评分和VAS比较均差异无统计学意义(P>0.05)。术后6周,微创组AOFAS前足评分、VAS明显优于传统组(P<0.05)。两组术后12个月HVA、IMA、AOFAS前足评分和VAS较术前改善(P<0.05)。结论:与传统Chevron截骨相比,微创截骨创伤小、恢复更快;而远期随访两者疗效相似,均可取得满意的疗效,但微创截骨治疗拇外翻需注意学习曲线。

Objective:To compare minimally invasive and traditional Chevron osteotomy in treating patients with mild to moderate hallux valgus. Methods:Clinical data of 36 patients(36 feet) with mild to moderate hallux valgus from January 2019 to February 2021 were retrospectively analyzed,and divided into minimally invasive osteotomy(minimally invasive group) and traditional Chevron osteotomy(traditional group). There were 16 patients in minimally invasive group,including 1 male and 15 females,aged from 36 to 60 years old with an average of(49.0±9.5) years old;9 were mild and 7 were moderate according to Mann classification;treated with minimally invasive osteotomy with hollow screw fixation. There were 20 patients(20 feet) in traditional group,including 2 males and 18 females,aged from 38 to 65 years old with an average of(50.0±9.2) years old;11 were mild and 9 were moderate according to Mann classification;treated with traditional Chevron osteotomy. Hallux valgus angle(HVA),intermetatarsal angle(IMA) before and after operation at 12 months bewteen two groups were observed and compared,and American Orthopedic Foot and Ankle Society(AOFAS) forefoot score and visual analogue scale(VAS) before and after operation at 6 weeks and 12 months between two groups were compared. Results:Thirty-six patiens were followed up from 14 to 30 months with an average of(21.00±5.77) months. All incisions were healed well at stageⅠwithout infection. There were no significant differences in HVA,IMA,AOFAS forefoot scores and VAS before and after operation at 12 months between two groups(P>0.05). However,AOFAS forefoot scores and VAS of minimally invasive group was significantly better than that of traditionl group at 6 weeks after operation(P<0.05). Postoperative HVA,IMA,AOFAS forefoot scores and VAS at 12 months bewteen two groups were improved better than that of preoperation(P<0.05). Conclusion:Compared with traditional Chevron osteotomy,minimally invasive osteotomy has less trauma and quicker recovery. Both of them has similar clinical effects,and could receive satisfactory clinical effects,while treatment of minimally invasive osteotomy should pain attention to learning curve.