两种截骨术式治疗中重度拇外翻影像学效果与临床疗效的系统评价

目的：系统评价Chevron截骨术与Scarf截骨术治疗中重度拇外翻的影像学效果和临床疗效。方法：计算机检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、万方期刊全文数据库（Wanfang Data）关于Chevron截骨术与Scarf截骨术治疗拇外翻的随机对照研究（RCT），检索时限从建库至2018年6月。由2名研究者独立按照纳入和排除标准筛选文献，评价纳入文献的偏倚风险和提取相关观察指标后，采用RevMan 5.3.5软件进行Meta分析。比较两种截骨术式术后拇外翻角（HVA）、1-2跖骨间角（IMA）、跖骨远端关节面固有角（DMAA）、美国骨科足踝外科协会评分（AOFAS）、术后切口并发症以及患者满意度。结果：最终纳入6篇随机对照研究文献，共507例（足）患者，92.5%的患者为中重度拇外翻，其中Chevron截骨术261例（足），Scarf截骨术246例（足）。Meta分析结果显示：Chevron截骨术在矫正HVA方面优于Scarf截骨术MD=-1.95，95% CI （-2.64，-1.27），P<0.000 01]。而两种方法在IMAMD=-0.42，95% CI （-1.04，0.21），P=0.19]，DMAAMD=0.78，95% CI （-0.72，2.29），P=0.31]，AOFAS评分MD=2.47，95% CI （-2.38，7.33），P=0.32]，术后切口并发症RR=1.09，95% CI （0.54，2.20），P=0.82]，患者满意度RR=1.00，95% CI （0.96，1.05），P=0.92]方面比较差异无统计学意义。结论：Chevron截骨术操作简单、跖骨短缩少、创伤小，在治疗中重度拇外翻矫正HVA方面优于Scarf截骨术，在IMA、DMAA、AOFAS评分、并发症、患者满意度方面二者效果相似。

Chevron osteotomy versus Scarf osteotomy for the efficacy of radiographic and clinical in moderate and severe hallux valgus: a systematic review

Objective:To evaluate efficacy of radiographic and clinical of Chevron osteotomy versus Scarf osteotomy for hallux valgus at moderate and severe degree.

Methods:Randomized controlled trial (RCT) about Chevron and Scarf osteotomy for hallux valgus,in PubMed,Embase,Cochrane Library,CBM,CNKI,Wanfang Data were searched by computer from establishing database to June 2018. According to inclusion and exclusion criteria,two researchers independently screened the literatures,evaluated risk of bias and extracted related observation index,RevMan 5.3.5 software was used to perform Meta-analysis. Postoperative hallux valgus angle (HVA),intermetatarsal angle (IMA),distal metatarsal articular angle (DMAA),AOFAS score,complications and patients'' satisfaction degree between Chevron and Scarf osteotomy.

Results:Six RCT literatures were included,involving 507 patients,92.5% patients were at moderate and severe degree,and 261 patients were performed by Chevron osteotomy and 246 patients were performed by Scarf osteotomy. Meta analysis results showed that Chevron osteotomy was better than Scarf osteotomy in correcting HVAMD=-1.95,95%CI(-2.64,-1.27),P<0.000 01]. While there were no statistical differences in IMAMD=-0.42,95%CI(-1.04,0.21),P=0.19],DMAAMD=0.78,95%CI(-0.72,2.29),P=0.31],AOFAS scoreMD=2.47,95%CI(-2.38,7.33),P=0.32],complicationsRR=1.09,95%CI(0.54,2.20),P=0.82],and patients'' satisfaction degreeRR=1.00,95%CI(0.96,1.05),P=0.92].

Conclusion:Chevron osteotomy,which has advantages in simple operation,shorten metatarsal bone,less trauma,was better in correcting HVA of hallux valgus at moderate and severe degree,and had similar effects in IMA,DMAA,AOFAS score,complications and patients'' satisfactory degree.