改良Chevron截骨術(shù)聯(lián)合收肌切斷術(shù)治療輕中度外翻

余　磊，左進步，宋立琨

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余磊1，左進步1，宋立琨2

外翻；改良Chevron截骨術(shù)；收肌切斷術(shù)

1　對象與方法

圖1　改良Chevron截骨術(shù)

1.4術(shù)后處理術(shù)后關(guān)節(jié)進行制動，傷口處繃帶包扎，為防止手術(shù)部位感染，可靜脈給予抗生素預(yù)防性治療，復(fù)查X線片，觀察手術(shù)部位關(guān)節(jié)愈合和恢復(fù)情況。術(shù)后1 d可穿前足免負重鞋下地活動，活動和功能鍛煉時避免手術(shù)關(guān)節(jié)負重，術(shù)后35～42 d可正常穿鞋活動。

1.5評價指標比較術(shù)前及末次隨訪時影像學(xué)資料，對比觀察手術(shù)前后HVA和IMA。同時根據(jù)美國足踝外科協(xié)會(The American Orthopedic Foot and Ankle Society，AOFAS)踇趾-跖趾-趾間關(guān)節(jié)評分系統(tǒng)[3]及視覺模擬評分法(visual analogue scale，VAS)[4]進行評分。

2　結(jié)　　果

圖2　改良Chevron截骨術(shù)X線片

項目術(shù)前術(shù)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：與術(shù)前比較，①P<0.05

3　討　　論

Lee等[10]認為，Chevron截骨術(shù)本身對關(guān)節(jié)的破壞已經(jīng)相當大，不宜再破壞周圍的軟組織，否則可能導(dǎo)致整個跖趾關(guān)節(jié)的可用組織大大減少，影響跖趾關(guān)節(jié)功能恢復(fù)和預(yù)后，甚至引起神經(jīng)損傷等并發(fā)癥。但是，如果不松解跖趾關(guān)節(jié)周圍的粘連，很可能導(dǎo)致畸形矯正無效，患者也會感覺跖趾關(guān)節(jié)活動不靈活，影響后期恢復(fù)和矯正效果。因此，筆者采用在改良Chevron截骨的基礎(chǔ)上配合周圍軟組織的松解治療。

總之，經(jīng)過病例回顧和相關(guān)理論實踐討論，本研究選擇了經(jīng)過改良的術(shù)式作為臨床推薦術(shù)式，并對這種術(shù)式的療效和預(yù)后情況進行了跟蹤調(diào)查，從而證實了改良后術(shù)式的臨床可行性，推薦臨床應(yīng)用。

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[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.

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[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)

(責任編輯尤偉杰)

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，碩士，主治醫(yī)師。

1.100027，武警北京總隊醫(yī)院骨科；2.100039北京，武警總醫(yī)院關(guān)節(jié)四肢科

左進步，E-mail: zjbjinbu@sina.com

R684.2