微创Chevron合并外侧软组织松解治疗轻中度拇外翻畸形的短期疗效分析
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作者Author单位AddressE-Mail
耿翔 GENG Xiang 复旦大学附属华山医院骨科, 复旦大学足踝疾病研究中心, 上海 200040 Department of Orthopaedics, Huashan Hospital, Fudan University, Foot and Ankle Research Center, Fudan University, Shanghai 200040, China  
王之枫 WANG Zhi-feng 复旦大学附属华山医院骨科, 复旦大学足踝疾病研究中心, 上海 200040 Department of Orthopaedics, Huashan Hospital, Fudan University, Foot and Ankle Research Center, Fudan University, Shanghai 200040, China  
王晨 WANG Chen 复旦大学附属华山医院骨科, 复旦大学足踝疾病研究中心, 上海 200040 Department of Orthopaedics, Huashan Hospital, Fudan University, Foot and Ankle Research Center, Fudan University, Shanghai 200040, China  
张超 ZHANG Chao 复旦大学附属华山医院骨科, 复旦大学足踝疾病研究中心, 上海 200040 Department of Orthopaedics, Huashan Hospital, Fudan University, Foot and Ankle Research Center, Fudan University, Shanghai 200040, China  
王旭 WANG Xu 复旦大学附属华山医院骨科, 复旦大学足踝疾病研究中心, 上海 200040 Department of Orthopaedics, Huashan Hospital, Fudan University, Foot and Ankle Research Center, Fudan University, Shanghai 200040, China wangxufoot@163.com 
马昕 MA Xin 复旦大学附属华山医院骨科, 复旦大学足踝疾病研究中心, 上海 200040 Department of Orthopaedics, Huashan Hospital, Fudan University, Foot and Ankle Research Center, Fudan University, Shanghai 200040, China  
期刊信息:《中国骨伤》2022年,第35卷,第9期,第830-835页
DOI:10.12200/j.issn.1003-0034.2022.09.006
基金项目:
中文摘要:

目的:探讨微创Chevron合并外侧软组织松解治疗轻中度拇外翻畸形的短期疗效。

方法:自2019年1月至2021年12月,采用微创Chevron截骨加外侧软组织松解术式治疗67例(80足)轻中度拇外翻患者,男5例(6足),女62例(74足);年龄20~60(47.2±9.7)岁;轻度(拇外翻角 ≤ 20°)54例(64足),中度(20°<拇外翻角 ≤ 40°)13例(16足)。比较术前与末次随访时拇外翻角(hallux valugs angle,HVA),Ⅰ-Ⅱ跖骨间角(Ⅰ-Ⅱ intermetatarsal anlge,Ⅰ-Ⅱ IMA),远端跖骨关节角(distal metatarsal articular angle,DMAA),籽骨Hardy评分变化,并采用北美足踝外科协会拇趾-跖趾关节(American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalanged-Interphalangeal,AOFAS Hallux MTP-IP)评分进行疗效评价。

结果:67例患者获得随访,时间6~23(13.7±6.5)个月。术前HVA、Ⅰ-Ⅱ IMA、DMAA、籽骨Hardy评分、AOFAS Hallux MTP-IP评分分别为(27.5±7.0)°,(17.4±4.1)°,(11.4±3.8)°,(4.9±2.6)分,(58.2±9.1)分;末次随访时时分别为(8.3±4.8)°,(6.9±3.0)°,(3.9±2.4)°,(2.7±1.1)分,(91.3±2.2)分;术前与末次随访比较差异有统计学意义(P<0.05)。轻度患足(64足)和中度患足(16足)术前各项影像学指标和AOFAS Hallux MTP-IP评分比较差异有统计学意义(P<0.05);末次随访时,上述指标比较差异无统计学意义(P>0.05);从各指标改善程度来看,中度拇外翻患足HVA、Ⅰ-ⅡIMA、籽骨Hardy评分、AOFAS Hallux MTP-IP评分优于轻度拇外翻患足(P<0.05)。术后4例出现截骨部位切口周围红肿,经局部换药及口服抗生素均治愈。

结论:微创Chevron截骨联合外侧软组织松解术对于轻中度拇外翻有良好的矫形效果及功能改善。
【关键词】拇外翻  微创外科手术  截骨矫形  软组织松解
 
Short-term results of minimally invasive Chevron osteotomy with lateral soft tissue release in treating mild to moderate hallux valgus
ABSTRACT  

Objective: To explore short-term results of minimally invasive Chevron osteotomy with lateral soft tissue release in treating mild to moderate hallux valgus.

Methods: Sixty patients (80 feet) with mild to moderate hallux valgus treated with minimally invasive Chevron osteotomy with lateral soft tissue release from January 2019 to December 2021 were retrospectively analyzed.Among them,there were 5 males (6 feet) and 62 females (74 feet),aged from 20 to 60 years old with an average of (47.2±9.7) years old;54 patients (64 feet) with mild hallux valgus,and 13 patients (16 feet) with moderate hallux valgus.Hallux valugs angle (HVA),Ⅰ-Ⅱ intermetatarsal anlge (Ⅰ-Ⅱ IMA),distal metatarsal articular angle (DMAA) and sesamoid Hardy score were compared before and after operation,and American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) scale was used to evaluate clinical effects.

Results: Sixty-seven patients (80 feet) were followed-up from 6 to 23 months with an average of (13.7±6.5) months.Preopertive HVA,Ⅰ-Ⅱ IMA,DMAA,sesamoid Hardy score and AOFAS Hallux MTP-IP were (27.5±7.0)°,(17.4±4.1)°,(11.4±3.8)°,(4.9±2.6) and (58.2±9.1),respectively;while at the final follow up were (8.3±4.8)°,(6.9±3.0)°,(3.9±2.4)°,(2.7±1.1) and (91.3±2.2);and there were statistical differences between pre-operation and the latest follow-up (P<0.05).There were differences in preopertaive imaging indexes and AOFAS Hallux MTP-IP between 64 mild and 16 moderate hallux valgus feet (P<0.05);while no difference in above indexes at the final follow-up (P>0.05);from the view of degree of improvement,HVA,Ⅰ-Ⅱ IMA,sesamoid Hardy score and AOFAS Hallux MTP-IP in moderate hallux valgus were better than that of in mild hallux valgus (P<0.05).Four patients occurred redness and swelling around incision on the osteotomy site,and cured by local dressing change and oral antibiotics.

Conclusion: Minimally invasive Chevron osteotomy combined with lateral soft tissue release has advantages of correction and functional improvement for mild to moderate hallux valgus.
KEY WORDS  Hallux valgus  Minimal surgical procedures  Osteotomy correction  Soft tissue release
 
引用本文,请按以下格式著录参考文献:
中文格式:耿翔,王之枫,王晨,张超,王旭,马昕.微创Chevron合并外侧软组织松解治疗轻中度拇外翻畸形的短期疗效分析[J].中国骨伤,2022,35(9):830~835
英文格式:GENG Xiang,WANG Zhi-feng,WANG Chen,ZHANG Chao,WANG Xu,MA Xin.Short-term results of minimally invasive Chevron osteotomy with lateral soft tissue release in treating mild to moderate hallux valgus[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(9):830~835
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