改良Chevron截骨术联合Akin截骨术治疗中重度(足母)外翻的临床分析

Clinical analysis of modified Chevron osteotomy combined with Akin osteotomy in the treatment of moderate and severe hallux valgus

目的探究改良Chevron截骨术联合Akin截骨术治疗中重度(足母)外翻的临床效果。方法回顾性分析2015年1月至2017年1月我院收治的50例中重度(足母)外翻病人的临床资料,依据手术治疗方式的不同将其分为改良Chevron截骨治疗组(20例,36病足)和联合手术治疗组(30例,50病足,改良Chevron截骨术联合Akin截骨术)。应用美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分系统评价患足功能,采用疼痛视觉模拟量表(visual analogue scale,VAS)评估两组病人患足疼痛情况,测量两组病人手术前后的外翻角(hallux valgus angle,HVA)和第1、2跖骨间角(inter-metatarsus angle,IMA)评价手术效果。结果联合手术治疗组病人的术中出血量为(33.75±5.27)ml,手术时间为(55.14±12.89)min,均高于改良Chevron截骨治疗组[(12.88±4.75)ml,(27.67±10.12)min],差异均有统计学意义(t=3.293,P=0.018;t=4.293,P=0.012)。联合手术治疗组术后1周、1个月、1年的VAS评分[(3.24±0.98)分、(2.17±0.45)分、(1.31±0.12)分]均优于改良Chevron截骨治疗组[(3.42±0.74)分、(2.57±0.36)分、(1.88±0.45)分],差异均有统计学意义(t=2.267,P=0.028;t=2.991,P=0.017;t=2.542,P=0.021)。两组病人术后的HVA、IMA、AOFAS评分、满意度评分、AOFAS优良率比较,联合手术治疗组[12.67°±2.13°、8.31°±1.02°、(81.21±9.24)分、(91.67±4.12)分、88.8%]优于Chevron截骨治疗组[10.42°±3.52°、7.59°±1.33°、(62.22±6.42)分、(75.32±5.91)分、60.00%],差异均有统计学意义(t=2.742,P=0.037;t=2.984,P=0.029;t=3.342,P=0.012;t=3.943,P=0.007;χ~2=7.274,P=0.032)。结论改良Chevron截骨术联合Akin截骨术治疗中重度(足母)外翻具有更好的术后效果,值得进一步推广应用。

Objective To explore the clinical effect of modified Chevron osteotomy combined with Akin osteotomy in the treatment of moderate and severe hallux valgus(HV).Methods Fifty patients with moderate and severe HV admitted to our hospital from January 2015 to January 2017 were selected and analyzed retrospectively. The patients were divided into modified Chevron osteotomy group(20 cases, 36 feet)and combined operation group(30 cases, 50 feet, modified Chevron osteotomy combined with Akin osteotomy)according to the different surgical treatments. The American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hind foot function score system was used to evaluate the function of the feet. Visual analogue scale(VAS) was used to evaluate the foot pain of the two groups. Hallux valgus angle(HVA) and the Inter-metatarsus angle(IMA) of first and second metatarsal bones of the two groups were measured before and after the operation to evaluate the effect of operation.Results The bleeding volume[(33.75±5.27) ml]was greater and operation time[(55.14±12.89) min]was longer in the combined operation group than those in the modified Chevron osteotomy group[(12.88±4.75) ml and(27.67±10.12) min], and the differences were statistically significant(t=3.293, P=0.018;t=4.293, P=0.012). The VAS score in the combined operation group(3.22±0.98, 2.17±0.45,1.31±0.12) was lower than that in the modified Chevron osteotomy group(3.42±0.74, 2.57±0.36, 1.88±0.45) at 1st week, 1st month and 1st year after operation, with statistical significance(t=2.267, P=0.028;t=2.991, P=0.017;t=2.542, P=0.021). The HVA and IMA, AOFAS score, satisfaction score, excellent and good rate of deformity correction in the combined operation group(12.67°±2.13°, 8.31°±1.02°, 81.21±9.24, 91.67±4.12,88.8%) were higher than those in the modified Chevron osteotomy group(10.42°±3.52°, 7.59°±1.33°, 62.22±6.42, 75.32±5.91, 60.00%), and the differences were statistically significant(t=2.742, P=0.037;t=2.984, P=0.029;t=3.342, P=0.012;t=3.943, P=0.007;χ~2=7.274, P=0.032).Conclusion Modified Chevron osteotomy combined with Akin osteotomy has better effect in the treatment of moderate and severe HV, which is worthy of further promotion and application.