改良Chevron截骨术联合收肌切断术治疗轻中度外翻

余　磊，左进步，宋立琨



余磊1，左进步1，宋立琨2

外翻；改良Chevron截骨术；收肌切断术

1　对象与方法

图1　改良Chevron截骨术

1.4术后处理术后关节进行制动，伤口处绷带包扎，为防止手术部位感染，可静脉给予抗生素预防性治疗，复查X线片，观察手术部位关节愈合和恢复情况。术后1 d可穿前足免负重鞋下地活动，活动和功能锻炼时避免手术关节负重，术后35～42 d可正常穿鞋活动。

1.5评价指标比较术前及末次随访时影像学资料，对比观察手术前后HVA和IMA。同时根据美国足踝外科协会(The American Orthopedic Foot and Ankle Society，AOFAS)踇趾-跖趾-趾间关节评分系统[3]及视觉模拟评分法(visual analogue scale，VAS)[4]进行评分。

2　结　　果

图2　改良Chevron截骨术X线片

项目术前术后HVA31.1°±4.3°14.8°±2.9°①IMA14.5°±3.4°7.4°±2.5°①AOFAS48.7±7.085.1±5.7①VAS6.5±1.32.1±0.7①

注：与术前比较，①P<0.05

3　讨　　论

Lee等[10]认为，Chevron截骨术本身对关节的破坏已经相当大，不宜再破坏周围的软组织，否则可能导致整个跖趾关节的可用组织大大减少，影响跖趾关节功能恢复和预后，甚至引起神经损伤等并发症。但是，如果不松解跖趾关节周围的粘连，很可能导致畸形矫正无效，患者也会感觉跖趾关节活动不灵活，影响后期恢复和矫正效果。因此，笔者采用在改良Chevron截骨的基础上配合周围软组织的松解治疗。

总之，经过病例回顾和相关理论实践讨论，本研究选择了经过改良的术式作为临床推荐术式，并对这种术式的疗效和预后情况进行了跟踪调查，从而证实了改良后术式的临床可行性，推荐临床应用。

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[2]王正义.足踝外科手术学[M].北京: 人民卫生出版社, 2009: 42.

[3]Kitaoka H B, Alexander I J, Adelaar R S,etal. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes [J]. Foot Ankle Int, 1994, 15(7): 349-353.

[4]Jensen M P, McFarland C A. Increasing the reliability and validity of pain intensity measurement in chronic pain patients [J]. Pain, 1993, 55(2): 195-203.

[6]Bai L B, Lee K B, Seo C Y,etal. Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity[J]. Foot Ankle Int, 2010, 31(8): 683-688.

[7]Freeman B L, Hardy M A. Multiplanar phalangeal and metatarsal osteotomies for hallux rigidus[J]. Clin Podiatr Med Surg, 2011, 28(2): 329-344.

[8]Vasso M, Regno C D, Amelio A D,etal. A modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus[J]. J Ortho and Traumato, 2015, 17(1): 1-5.

[10]Lee H J, Chung J W, Chu I T,etal. Comparison of distal chevron osteotomy with and without lateral soft tissue release for the treatment of hallux valgus[J]. Foot Ankle Int, 2010,31(4): 291-295.

(2016-03-03收稿2016-08-12修回)

(责任编辑尤伟杰)

Modified Chevron osteotomy combined with adductor pollicis amputation for treatment of mild or moderate hallux valgus

YU Lei1, ZUO Jinbu1, and SONG Likun2.

1. Department of Orthopaedics, Beijing Municipal Corps Hospital, Chinese People’s Armed Police Forces, Beijing 100027, China; 2. Department of Orthopaedics, General Hospital of Chinese People’s Armed Police Forces, Beijing 100039, China

ObjectiveTo evaluate the clinical effect of modified Chevron osteotomy combined with adductor pollicis amputation for treatment of mild or moderate hallux valgus by observing patients’recovery and prognosis. MethodsThe pre-operative and post-operative clinical data of 36 cases of mild or moderate hallux valgus (50 feet) were analyzed retrospectively. The AOFAS and VAS for the effect of operation were quantified. ResultsThe scores and follow-up results showed that postoperative hallux valgus symptoms of all the patients had greatly improved. No wound infection, necrosis of the metatarsal head or nonunion was observed. The mean pre-operative HVA was 31.1°±4.3°, but was decreased to 14.8°±2.9°(P<0.05) post-operatively. IMA was decreased from 14.5°±3.4° to 7.4°±2.5°(P<0.05). The mean AOFAS score was improved from 48.7±7.0 points to 85.1±5.7 points(P<0.05).According to the performance assessment, 20 cases (26 feet) were excellent, 12 (19 feet) were good, and 4 cases (5 feet) were average, with an excellent and good rate of 90%. ConclusionThe modified Chevron osteotomy combined with adductor pollicis amputation can be used in the treatment of mild or moderate hallux valgus to a good. effect This approach is worthy of improvement and clinical application .

hallux valgus; modified Chevron osteotomy; adductor pollicis amputation

余磊，硕士，主治医师。

1.100027，武警北京总队医院骨科；2.100039北京，武警总医院关节四肢科

左进步，E-mail: zjbjinbu@sina.com

R684.2