单切口改良Chevron截骨联合软组织松解在中重度踇外翻矫形中的应用

Application of Single Incision Modified Chevron Osteotomy Combined with Soft Tis-sue Release in Correction of Moderate and Severe Valgus

目的:探讨采用单切口改良Chevron截骨联合软组织松解手术治疗中重度足踇外翻的临床效果。方法:回顾性分析2018年6月至2022年12月我院收治的30例(42足)采用单切口改良Chevron截骨联合软组织松解手术治疗中重度踇外翻的患者资料,其中男性2例,女性28例;年龄23~65岁,平均(41.5 ± 12.5)岁。比较患者术前及末次随访时的踇外翻角(HVA)、跖骨远端固有角(PASA)和第1、2跖骨间夹角(IMA)、前中足美国足踝外科协会(AOFAS)评分、疼痛视觉模拟评分(VAS)的差异进行统计学分析,记录患者满意度及并发症。结果:30例患者术后随访12~24个月,平均(18.5 ± 5.5)个月,所有病例均获得满意的矫形效果,无畸形复发、切口感染、跖骨头坏死、踇内翻等并发症。截骨端均获得骨性愈合,2例患者术后出现跖趾关节僵硬,无其他不适,综合分析考虑患者术后石膏佩戴时间过长(患者自诉自行固定6周),术后康复锻炼不足有关,经过专业康复锻炼后治愈。末次随访时AOFAS评分和VAS评分均较术前有明显改善,差异有统计学意义(P < 0.05)。HVA、IMA、DMAA较术前均获较大改善,差异有统计学意义(P < 0.05)。结论:对于中重度足踇外翻,应用单切口改良Chevron截骨联合软组织松解手术治疗,切口小、术后外观美观、患者满意度高,是对外观要求较高年轻女性患者的首选术式。

Objective: To investigate the clinical effect of single incision modified Chevron osteotomy combined with soft tissue release in the treatment of moderate and severe hallux valgus. Methods: The clinical data of 30 patients (42 feet) with moderate and severe valgus treated by single incision modified Chevron osteotomy combined with soft tissue release from June 2018 to December 2022 were ana-lyzed retrospectively, including 2 males and 28 females, aged 23 to 65 years (mean 41.5 ± 12.5) years. The differences of valgus angle (HVA), intrinsic angle of distal metatarsal (PASA), inter-metatarsal angle between the first and second metatarsals (IMA), American association of foot and ankle surgical association (AOFAS) score and visual analogue score (VAS) of anterior middle foot were compared before and at the last follow-up. Patient satisfaction and complications were rec-orded. Results: 30 patients were followed up for 12 to 24 months, with an average of (18.5 ± 5.5) months. All patients achieved satisfactory orthopedic results. There were no complications such as deformity recurrence, incision infection, metatarsal head necrosis and varus varus. Bone healing was achieved at the end of osteotomy. 2 patients had metatarsophalangeal joint stiffness and no other discomfort. Comprehensive analysis considered that the patients wore plaster for too long af-ter operation (self-reported self-fixation for 6 weeks) and postoperative rehabilitation exercise is related to insufficiency, and it is cured after professional rehabilitation exercise. At the last fol-low-up, the AOFAS score and VAS score were significantly improved compared with those before operation, and the difference was statistically significant (P < 0.05). HVA, IMA and DMAA were sig-nificantly improved compared with those before operation (P < 0.05). Conclusion: For moderate and severe foot valgus, single incision modified Chevron osteotomy combined with soft tissue release has the advantages of small incision, beautiful appearance and high patient satisfaction, which is the first choice for young female patients with higher appearance requirements.