改良Chevron截骨手术矫正中重度足[母]外翻

A modified Chevron osteotomy for correction of moderate to severe hallux valgus deformity

[目的]探讨改良Chevron截骨手术治疗中重度足[母]外翻的临床疗效。[方法]2019年1月—2021年1月对50例中重度足[母]外翻患者行第1跖骨远端改良Chevron截骨,评价临床及影像结果。[结果]手术时间平均(50.2±18.3)min,出血量(45.8±12.0)ml,所有患者手术切口均Ⅰ期愈合。所有患者平均随访(8.1±2.1)个月,随着自术前、术后3个月至末次随访的时间推移,VAS评分[(5.8±1.2),(2.3±0.5),(1.5±0.3),P<0.001]和AOFAS评分[(66.9±7.9),(82.7±6.6),(93.8±4.1),P<0.001]均显著改善。影像方面,[母]外翻角(hallux valgus angle,HVA)[(34.3±5.3)°,(7.7±2.1)°,(7.8±1.9)°,P<0.001]、第1、2跖骨角(intermetatarsal angle,IMA)[(13.5±3.3)°,(5.2±1.4)°,(5.3±1.2)°,P<0.001]和跖骨远端关节角(distal metatarsal articular angle,DMAA)[(19.7±3.6)°,(7.1±1.6)°,(7.2±1.8)°,P<0.001]亦显著改善。截骨平均愈合时间为(10.9±2.2)周。至末次随访均无骨不连、第一跖骨头坏死、骨髓炎等不良影像学改变。[结论]第1跖骨远端改良Chevron截骨手术治疗中重度足[母]外翻近期效果满意,是较为可靠的治疗手段。

[Objective]To investigate the clinical outcome of a modified Chevron osteotomy in the treatment of moderate and severe hallux valgus.[Methods]From January 2019 to January 2021,50 patients with moderate and severe bunion valgus underwent the modified Chevron osteotomy at the distal first metatarsal.The clinical and imaging consequences in short term were evaluated.[Results]All patients had the surgical procedure performed smoothly with the average operation time of(50.2±18.3)min,the amount of blood loss of(45.8±12.0)mL,and incisions healed in stage I.All patients were followed up for an average of(8.1±2.1)months.With time from preoperatively to 3 months postoperative and the last follow-up,the VAS score[(5.8±1.2),(2.3±0.5),(1.5±0.3),P<0.001]and AOFAS score[(66.9±7.9),(82.7±6.6),(93.8±4.1),P<0.001]are improved significantly.Regarding image,the hallux valgus angle(HVA)[(34.3±5.3)°,(7.7±2.1)°,(7.8±1.9)°,P<0.001],1,2 intermetatarsal angle(IMA)[(13.5±3.3)°,(5.2±1.4)°,(5.3±1.2)°,P<0.001]and distal metatarsal articular angle(DMAA)[(19.7±3.6)°,(7.1±1.6)°,(7.2±1.8)°,P<0.001]were also significantly improved.The mean healing time of osteotomy was of(10.9±2.2)weeks,and no adverse imaging changes such as bone nonunion,necrosis of the first metatarsal head,osteomyelitis,etc were found in anyone of them until the last follow-up.[Conclusion]This modified Chevron osteotomy at the distal first metatarsal is a reliable method for the treatment of moderate and severe bunions with satisfactory short-term results.