| 改良Chevron截骨术治疗中重度足拇外翻 |
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投稿时间：2021-03-11
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| 作者 | Author | 单位 | Address | E-Mail |
| 余建华 |
YU Jian-hua |
安吉县第二人民医院骨科, 浙江 安吉 313107 |
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| 方添顺 |
FANG Tian-shun |
湖州市中心医院浙江大学医学院附属湖州医院骨科, 浙江 湖州 313000 |
Huzhou Central Hospital of Zhejiang Provice, Huzhou Hospital of Zhejiang University School of Medicine, Huzhou 313000, Zhejiang, China |
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| 宋涛 |
SONG Tao |
安吉县第二人民医院骨科, 浙江 安吉 313107 |
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| 吴猛 |
WU Meng |
湖州市中心医院浙江大学医学院附属湖州医院骨科, 浙江 湖州 313000 |
Huzhou Central Hospital of Zhejiang Provice, Huzhou Hospital of Zhejiang University School of Medicine, Huzhou 313000, Zhejiang, China |
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| 李雄峰 |
LI Xiong-feng |
湖州市中心医院浙江大学医学院附属湖州医院骨科, 浙江 湖州 313000 |
Huzhou Central Hospital of Zhejiang Provice, Huzhou Hospital of Zhejiang University School of Medicine, Huzhou 313000, Zhejiang, China |
lyfwind@126.com |
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| 期刊信息：《中国骨伤》2022年，第35卷，第1期，第90-94页 |
| DOI：10.12200/j.issn.1003-0034.2022.01.018 |
| 基金项目: |
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中文摘要:
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；双侧2例4足；病程3～12（9.32±3.89）年。测量并比较术前和术后6个月拇外翻角（hallux valgus angle，HVA），第1，2跖骨间夹角（intermetatarsal angle，IMA），第1跖骨远端关节面角（distal metatasal articular angle，DMAA）变化情况，并采用美国足踝外科学会（American Orthopedic Foot and Ankle Society，AOFAS）拇趾关节评分系统进行疗效评价。
结果：28例患者获得随访，时间8～16（11.28±3.42）个月。所有患者术后手术切口愈合良好，未出现切口感染、跖骨头坏死等并发症。截骨部位愈合时间6～10（7.12±1.34）周。术前HVA、IMA、DMAA、AOFAS分别为（36.06±6.02）°、（21.78±4.16）°、（8.21±2.65）°、（52.90±10.97）分，术后6个月分别为（8.87±2.46）°、（11.66±2.84）°、（3.65±1.00）°、（87.45±10.55）分，术前与术后6个月比较差异有统计学意义（P<0.05）。术后6个月根据AOFAS评分，优20足，良7足，差3足。3例评分差的患者2例翻修后达到优良，1例采用定制鞋垫后明显改善。
结论：改良Chevron可有效的纠正HVA、IMA、DMAA，提高功能恢复情况。改良Chevron截骨术式推移距离增加，截骨面接触增大，可以使用多枚螺钉固定，有较强的矫正能力，并可早期功能锻炼，是中重度拇外翻手术治疗可选择的方法之一。 |
| 【关键词】拇趾外翻 截骨术 关节囊松解 |
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| Modified Chevron osteotomy in the treatment of moderate and severe hallux valgus |
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ABSTRACT
Objective: To investigate the method and clinical effect of modified Chevron osteotomy of the distal end of the first metatarsal in the treatment of moderate and severe hallux valgus.
Methods: From January 2015 to January 2019,28 patients(30 feet) with moderate and severe hallux valgus were treated with modified Chevron osteotomy combined with lateral soft tissue release of the first metatarsophalangeal joint,including 2 males (2 feet) and 26 females (28 feet). The age ranged from 35 to 74 (57.3±9.3) years;10 feet on the left,16 feet on the right,2 cases on both sides(4 feet);the course of disease was 3 to 12 (9.32±3.89) years. The changes of hallux valgus angle(HVA),intermetatarsal angle(IMA) between the first and second metatarsals and distal metatarsal articular angle(DMAA) of the first metatarsal were measured and compared before and 6 months after operation. The American Orthopaedic Foot and Ankle Society(AOFAS) thumb joint scoring system was used to evaluate the curative effect.
Results: All 28 patients were followed up for 8 to 16 (11.28±3.42) months. The incision healed well in all patients,and there were no complications such as incision infection and metatarsal head necrosis. The healing time of osteotomy site was 6 to 10(7.12±1.34) weeks. Preoperative HVA,IMA,DMAA and AOFAS were (36.06±6.02)°,(21.78±4.16)°,(8.21±2.65)° and (52.90±10.97) respectively,at six months after operation,they were (8.87±2.46)°,(11.66±2.84)°,(3.65±1.00)° and (87.45±10.55) respectively,there was significant difference between preoperative and 6 months after operation(P<0.05). At 6 months after operation,AOFAS score was excellent in 20 feet,good in 7 feet and poor in 3 feet. Among the 3 patients with poor scores,2 were excellent after revision,and 1 was significantly improved after using custom insoles.
Conclusion: Modified Chevron can effectively correct HVA,IMA and DMAA and improve functional recovery. The modified Chevron osteotomy increases the moving distance and the contact of the osteotomy surface. It can be fixed with multiple screws,has strong correction ability,and can exercise early. It is one of the optional methods for the treatment of moderate and severe hallux valgus. |
| KEY WORDS Hallux valgus Osteotomy Joint capsule release |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 余建华,方添顺,宋涛,吴猛,李雄峰.改良Chevron截骨术治疗中重度足拇外翻[J].中国骨伤,2022,35(1):90~94 |
| 英文格式: | YU Jian-hua,FANG Tian-shun,SONG Tao,WU Meng,LI Xiong-feng.Modified Chevron osteotomy in the treatment of moderate and severe hallux valgus[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(1):90~94 |
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