改良偏距Chevron结合Akin截骨治疗中重度外翻畸形的研究

目的 评估第一跖骨远端改良偏距Chevron结合Akin截骨治疗中重度外翻畸形的疗效和安全性。 方法 自2015年7月-2016年10月,经治16例16足中重度外翻患者,男性2例,女性14例;年龄33~45岁,平均38.5岁。排除跖趾关节重度骨关节炎、跖骨头颈窄小、跖楔关节松弛等,采用第一跖骨远端偏距Chevron截骨,截骨顶点位于跖骨头冠状面中上部,距跖骨头软骨面背缘近端约4 mm,距背侧骨皮质约5 mm,截骨顶角约100°,截骨上臂垂直背侧皮质,下臂延伸至跖骨1/2处,推移矫形后螺钉固定。比较术前、后外翻角(hallux valgus angle,HVA)、第1、2跖骨间角(intermetatarsal angle,IMA),视觉模拟评分法(visual analogue scale,VAS)比较足痛,美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)第一跖趾关节评分标准及患者主观满意度评估。 结果 16例均获随访,随访时间(13.5±1.5)个月,末次随访时HVA、IMA、VAS、AOFAS评分均较术前明显改善,差异有统计学意义(P<0.01),患者主观满意度高。术后6周内截骨端均临床愈合,至末次随访无跖骨头坏死。 结论 第一跖骨远端改良偏距Chevron结合Akin截骨,矫形力强,截骨端稳定,利于固定,骨愈合快,手术简便,能有效矫治中重度外翻,并发症少。 

Correction of moderate to severe hallux valgus with modified offset-V distal chevron and Akin osteotomy

Objective To evaluate the clinical efficacy and safety of modified offset-V distal Chevron and Akin Osteotomy in treating moderate to severe hallux valgus deformities. Methods From July, 2015 to October, 2016, 16 patients (2 men and 14 women, mean age of 38.5 years) 16 foot of moderate to severe hallux valgus deformities were treated with modified offset distal Chevron and Akin Osteotomy. The Hallux valgus angle(HVA), intermetatarsal angle (IMA), visual analogue scale(VAS) and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal Clinical Rating Score before operation were compared with that after the operation. Results All patients tolerated the procedure well. Complications such as avascular necrosis or bone nonunion were not demonstrated in the study. The HVA, IMA, VAS and AOFAS Hallux Metatarsophalangeal Interphalangeal Clinical Rating Score were improved obviously(P<0.01). Conclusion The modified Offset-V distal Chevron and Akin Osteotomy is a safe, conveniently and effective therapy for moderate to severe hallux valgus deformities.