Chevron osteotomy for the treatment of hallux valgus

Seventy-six chevron osteotomies with follow-up periods ranging from six months to eight years were reviewed. The majority of patients had pain over the bunion prior to operation, and 27 also presented with second metatarsalgia. After surgery there was a marked decrease of pain in the first metatarsophalangeal joint, and in 18 feet the second metatarsalgia was either eliminated or markedly decreased. Most patients were pleased with the appearance of the feet after surgery, but almost one-third of the women complained of difficulty in wearing high heels. The surgical technique is straightforward, but careful attention to detail is necessary to obtain a consistent and satisfactory result.     

Chevron osteotomy for hallux valgus.

The chevron osteotomy for realignment of the first metatarsal head in metatarsus primus varus deformity has been utilized at the Mayo Clinic since 1976 on 26 feet (18 patients). Follow-up evaluation disclosed excellent relief of pain, good cosmetic correction, and overall patient satisfaction. Radiographic evaluation demonstrated reduction in the angle between the phalanx and the metatarsal bone of the great toe as well as narrowing of the forefoot with a decreased angle between the first and the second metatarsal bones. The stability of the osteotomy, the technical ease, and the absence of secondary difficulties such as transfer metatarsalgia make this procedure preferable when osteotomy of the distal portion of the first metatarsal bone is used for correction of moderate deformity.     

改良Chevron 截骨术治疗中重度足拇外翻

目的:探讨第1跖骨远端改良Chevron截骨治疗中重度拇外翻的方法和临床疗效.方法:2015年1月至2019年1月采用改良Chevron截骨结合第1跖趾关节外侧软组织松解手术治疗28例(30足)中重度拇外翻患者,其中男2例(2足),女26例(28足);年龄35 ～74 (57.3±9.3)岁;左侧10足,右侧16足;双...     

Chevron osteotomy of the first metatarsal for hallux valgus

A retrospective study of 50 chevron osteotomies evaluated subjective and objective functional and cosmetic results, which were in keeping with other reported studies--i.e. satisfactory subjective cosmesis in 98%; excellent or good pain relief in 84%; and satisfactory objective cosmesis in 84%. The correction of the 1st intermetatarsal angle averaged 3.3 degrees, and that of the metatarsophalangeal valgus averaged 15 degrees. Average active range of motion of the 1st metatarsophalangeal joint was 60 degrees. Complications were generally mild and asymptomatic, and were usually iatrogenic. The findings of this study, together with information gained from a concomitant stress analysis, led to recommendations regarding operative technique.     

第1跖骨远端改良Chevron截骨治疗[足母]外翻

背景：[足母]外翻的手术治疗方式众多,传统Chevron有一定的手术操作局限性。目的：观察采用第1跖骨远端改良Chevron截骨治疗轻中度[足母]外翻的临床治疗效果。方法：2011年12月至2012年10月采用Chevron截骨对22例患者（28足）进行[足母]外翻矫正,记录患者术前、术后美国足踝外科医师协会评分（AOFAS）,术前、术后测量第1、2跖骨间角（IMA）和躅外翻角（HVA）变化以评估矫正程度,采用AOFAS前足评分和生活功能评分简表（SF．36）评估功能恢复情况。结果：22名患者术后平均随访时间13．36个月（8～18个月）,术前患者平均AOFAS评分（43．59±6．85）分,术后平均85．55±5．66分。术前患者平均SF．36量表评分（45．42±5．54）分,术后平均（83．23±8．81）分,两者术前、术后比较有显著统计学差异（P〈0．01）。IMA术前13．80°±1．67°,术后6．70°±1．51°（P〈0．01）;HVA术前平均29．30°±2．78°,术后7．47°±2．82。（P〈0．01）。结论：第1跖骨远端改良Chevron截骨治疗轻中度蹰外翻手术操作技术简便,临床效果满意。     

Chevron osteotomy versus scarf osteotomy for hallux valgus correction: A meta-analysis

BackgroundThis study intended to investigate the optimal surgical strategy in hallux valgus (HV), and to provide a basis for clinical treatment of HV.MethodsStudies related to chevron osteotomy and scarf osteotomy for HV were enrolled from online databases. Hallux valgus angle (HVA) was the main outcome variable. Enrolled studies included posttreatment data for intermetatarsal angle (IMA), American Orthopaedic Foot & Ankle Society (AOFAS) score, and complications. A random-effects model was applied for significant heterogeneity. Otherwise, a fixed-effects model was used. Heterogeneity was assessed with Q test and I² statistics. Publication bias was evaluated with Egger's test. Based on the influence of weighted mean difference values or odds ratios, a sensitivity analysis was performed.ResultsFour studies including 384 subjects were evaluated to determine the optimal surgical strategy for HV. There was no statistically significant difference between chevron and scarf groups for HVA, IMA, AOFAS score, and complication rates. Sensitivity analysis showed good stability. The likelihood of publication bias was small.ConclusionThe effects of chevron osteotomy and scarf osteotomy for HV are comparable. Chevron osteotomy is less technically demanding.     

Chevron osteotomy in hallux valgus. Ten-year results of 112 cases

The Chevron osteotomy was described in 1976. There have, however, been only short- to mid-term follow-up reviews, often with small numbers of patients. We looked at 112 feet (73 patients) with a minimum follow-up of ten years following Chevron osteotomy with a distal soft-tissue procedure. Clinical evaluation was calculated using the hallux score of the American Orthopedic Foot and Ankle Society (AOFAS). For 47 feet (30 patients), the results were compared with those from an interim follow-up of 5.6 years. The AOFAS-score improved from a pre-operative mean of 46.5 points to a mean of 88.8 points after a mean of 12.7 years. The first metatarsophalangeal (MTP) angle showed a mean pre-operative value of 27.6 degrees and was improved to 14.0 degrees. The first intermetatarsal (IM) angle improved from a pre-operative mean value of 13.8 degrees to 8.7 degrees. The mean pre-operative grade of sesamoid subluxation was 1.7 on a scale from 0 to 3 and improved to 1.2. Measured on a scale from 0 to 3, arthritis of the first MTP joint progressed from a mean of 0.8 to 1.7. Comparing the results in patients younger and older than 50 years, the Chevron osteotomy performed equally in both age groups. Analysing the subgroup of 47 feet with a post-operative follow-up of both 5.6 and 12.7 years, the AOFAS pain and the overall score showed a further improvement between both follow-up evaluations. The MTP angle, first IM angle and sesamoid position remained unchanged. The progression of arthritis of the first MTP joint between 5.6 and 12.7 years post-operatively was statistically significant. Only one patient required a revision procedure due to painful recurrence of the deformity. Excellent clinical results following Chevron osteotomy not only proved to be consistent, but showed further improvement over a longer follow-up period. The mean radiographic angles were constant without recurrence of the deformity. So far, the statistically significant progression of first MTP joint arthritis has not affected the clinical result, but this needs further observation.     

经皮Chevron截骨术治疗轻中度足拇外翻畸形

目的评估经皮Chevron截骨术治疗轻中度足拇外翻畸形的疗效。方法 2010年6月至2012年5月,采用经皮Chevron截骨术治疗24位(26例)轻中度足拇外翻患者。所有患者均为女性,平均年龄48岁,其中右足14例,左足12例。术前和末次随访时测量足拇外翻角、跖骨间角,并进行美国足踝骨科学会(AOFAS)前足评分。术前足拇外翻角20°~40°,跖骨间角小于20°,跖骨远端关节角小于10°。结果术后平均随访26.3个月,足拇外翻角由术前平均31.68°纠正至术后平均14.39°,跖骨间角由术前平均13.77°纠正至术后平均7.98°,AOFAS前足评分由术前平均59.26分改善至术后平均88.35分。术后4例出现内侧关节囊折叠缝合引起的刺激症状,4例出现螺钉尾端刺激症状,但无伤口感染、关节僵硬及跖骨头坏死等并发症发生。结论经皮Chevron截骨术中期随访结果较好,可有效治疗轻中度足拇外翻畸形。     

改良Chevron截骨术联合Akin截骨术治疗足母中重度外翻的临床分析

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足母外翻角（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;χ²=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。     

Chevron osteotomy for correction of hallux valgus: a long-term follow-up study

Seventy-six consecutive patients with 106 bunions were examined 6 years after chevron osteotomy. The feet were evaluated clinically and radiologically. The American Orthopaedic Foot and Ankle Society (AOFAS) scale (0–100) was used. The mean age of the patients was 46 years at time of operation. Ninety-six % of the operated patients were female. At 6 year follow-up, the hallux valgus angle was 17,9 degrees (range, 2–42 degrees) and the intermetatarsal angle was 10,5 degrees (range, 4–20 degrees). The change of the hallux valgus angle (compared to the preoperative X-ray picture) was 6,4 degrees (P<0,001, 95% confidence interval 4,0 to 8,7 degrees). The mean AOFAS score was 81 (±SD15). The study indicates that the long term results of chevron osteotomy are variable. The clinical evidence of effectiveness is still weak and there is an obvious need for randomized controlled trials in this field.     

第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻

目的 :探讨第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻的临床疗效。方法:自2015年6月至2017年6月,采用第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻32例(40足),其中男3例3足,女29例37足;年龄22～80岁,平均57.57岁;病程2～32年,平均14年;轻度9足,中度31足。术前患者合并拇囊炎,伴有第1跖趾关节周围疼痛并存在负重行走时疼痛加重。手术前后拍摄足负重正侧位片,比较拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),并采用美国足踝外科协会拇外翻评分(AOFAS)评价临床疗效。结果:32例患者获得了随访,时间12～24个月,平均15.2个月。术后切口均愈合良好,无感染、跖骨头坏死等并发症发生。术前HVA、IMA分别由(32.08±5.59)°、(11.63±2.24)°减小至术后12个月的(10.31±4.36)°、(5.02±2.34)°,差异有统计学意义(P0.05)。AOFAS评分由术前的56.75±6.42提高至术后12个月的88.80±3.99 (P0.05)。结论:第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻畸形可获得较好的临床效果,为拇外翻治疗提供了更多的选择。     

Wilson's osteotomy for the treatment of hallux valgus

One hundred oblique distal first metatarsal osteotomies (Wilson's) were reviewed at an average of five years and two months following surgery. In 96 feet there was pain over the bunion or first metatarsophalangeal joint preoperatively. This pain was eliminated in 85 feet and improved in nine feet. Second metatarsalgia present preoperatively was relieved in five of seven feet, but 19 feet developed second metatarsalgia following surgery. The majority of patients were pleased with the outcome of the surgery. No significant complications were noted. The surgical technique of Wilson's first metatarsal osteotomy for hallux valgus is straight-forward and produces a predictably excellent result.     

Distal L osteotomy in treatment of hallux abducto valgus

The distal L osteotomy is a useful and versatile procedure for the treatment of mild-to-moderate hallux abducto valgus. A review of common distal osteotomies was presented, along with the original indications and procedural disadvantages. The operative procedure of the distal L osteotomy, coupled with various modifications and complications was described. It is hoped that this brief paper will stimulate interest and use of this valuable osteotomy.     

改良Ludloff截骨术治疗严重Mu外翻

目的总结改良Ludloff截骨术治疗严重(足母)外翻的疗效.方法自1999年3月～2000年12月,采用改良Ludloff截骨术结合其它手术治疗严重(足母)外翻患者56例(63足).男3例(3足),女53例(60足);年龄16～65岁,平均46岁.选择第一、二跖骨间夹角大于16°的严重(足母)外翻患者行改良Ludloff截骨术,4足加行Reverdin截骨,3足加行Akin截骨.随访时间6～18个月,平均10个月,所有患者均拍摄患足负重位X线片并测量,采用美国足踝外科协会Maryland评分标准对疗效进行评定,与目前临床常用截骨方法进行比较,对改良Ludloff截骨术优缺点进行分析.结果术后无不愈合或迟缓愈合,无感染.Maryland(足母)跖趾关节评分90～100分者41足(65%),80～89分者17足(27%),70～79分者5足(8%),优良率为92%.结论改良Ludloff截骨术具有跖骨短缩少、愈合快、纠正畸形能力强、坚固内固定可使患者早期下地活动等优点,是治疗第一、二跖骨间夹角大于16°且无跖趾关节骨性关节炎的严重(足母)外翻的一种较理想的手术方法.     

Surgical treatment of hallux valgus by peg osteotomy]

Authors describe a method of therapy of hallux valgus not yet published in this country. Its advantage is that as a consequence of the shortening of the proximal phalanx the tension of the soft tissues is decreased and as a final result the movement occurs between the original cartilaginous surfaces.     

Surgical treatment of adolescent's hallux valgus using Scarf's osteotomy

14 patients were operated for hallux valgus using the Scarf technique. The mean age of patients was 15.5 years, in 7 the deformation was bilateral. The hallux valgus was medium in 18 cases and the mean angle of the valgus was 35 degrees. The patients were examined 1 year after surgical procedure and 18 results were good and 3 satisfactory.     

The distal metatarsal osteotomy for the treatment of hallux valgus

This article discusses various forms of distal metatarsal osteotomy for the treatment of hallux valgus. The techniques for the various osteotomies have evolved over the years to allow the surgeon to match a procedure and its modifications to the individual patient's deformity, thus optimizing outcomes. Fixation techniques continue to evolve, and meticulous surgical technique to prevent complications remains a must. Regardless of the osteotomy used, the authors believe that adherence to the techniques laid out in current literature will provide gratifying results for the surgeon and the patient.     

改良Ludloff截骨术治疗严重外翻

目的总结改良Ludloff截骨术治疗严重外翻的疗效。方法自1999年3月～2000年12月,采用改良Ludloff截骨术结合其它手术治疗严重外翻患者56例(63足)。男3例(3足),女53例(60足);年龄16～65岁,平均46岁。选择第一、二跖骨间夹角大于16°的严重外翻患者行改良Ludloff截骨术,4足加行Reverdin截骨,3足加行Akin截骨。随访时间6～18个月,平均10个月,所有患者均拍摄患足负重位X线片并测量,采用美国足踝外科协会Maryland评分标准对疗效进行评定,与目前临床常用截骨方法进行比较,对改良Ludloff截骨术优缺点进行分析。结果术后无不愈合或迟缓愈合,无感染。Maryland跖趾关节评分90～100分者41足(65%),80～89分者17足(27%),70～79分者5足(8%),优良率为92%。结论改良Ludloff截骨术具有跖骨短缩少、愈合快、纠正畸形能力强、坚固内固定可使患者早期下地活动等优点,是治疗第一、二跖骨间夹角大于16°且无跖趾关节骨性关节炎的严重外翻的一种较理想的手术方法。