内侧单切口改良Chevron截骨联合关节外侧组织松解治疗轻中度拇外翻临床观察

摘要

目的:探讨内侧切口改良Chevron截骨结合外侧组织松解治疗轻中度拇外翻的临床疗效.方法:自2015年7月至2016年6月采用改良Chevron截骨结合外侧组织松解治疗轻中度拇外翻患者26例,其中男2例,女24例;年龄45～65(54.6±4.8)岁;病程1～5(7.5±3.3)个月.术后12个月末次随访时测量患足HVA(拇外翻角)、IMA(第1、2跖骨间角),并采用AOFAS评分比较手术前后临床疗效.结果:术后26例患足切口均Ⅰ期愈合,未出现切口感染、跖骨头坏死、拇外翻畸形复发等并发症,其中2例出现皮肤轻度麻木症状,考虑皮神经损伤引起.26例患者获得随访,时间6～12(9.12±2.06)个月,术前HVA (30.01±3.71)°、IMA(14.00±1.50)°与术后的(9.41±4.16)°、(7.00±0.60)°比较差异有统计学意义.术前AOFAS评分为54.77±9.59与术后的92.73±5.47比较差异有统计学意义,其中优19例,良7例.结论:内侧单切口行改良Chevron截骨(必要时加做Akin截骨)并Acutrak全螺纹无头加压螺钉固定,并适度松解关节外侧软组织以治疗轻、中度拇外翻,具有暴露充分、操作简便、固定牢固、愈合较快的优势,而且通过适度的外侧松解,必要时Akin截骨配合内侧关节囊紧缩,较好地恢复内外侧软组织平衡,取得了较为满意的临床效果.%Objective:To explore clinical effect of modified Chevron osteotomy combined with lateral tissue loosening for the treatment of mild-moderate hallux valgus through internal signal approach.Methods:From July 2015 to June 2016,26 patients with mild-moderate hallux valgus treated with modified Chevron osteotomy combined with lateral tissue loosening through internal signal approach,including 2 males and 24 females aged from 45 to 65 years old with an average of (54.6±4.8) years old;the courses of diseases ranged from 1 to 5 months with an average of (7.5±3.3) months.Hallux valgus angle (HVA),inter metatarsal angle (IMA) were measured at 12 months after operation,and AOFAS score was applied to evaluate clinical effect before and after operation.Results:All incisions were healed at stage Ⅰ.No incision occurred infection,metatarsal necrosis and recurrence of hallux valgus deformity.Two patients occurred skin numbness caused by musculocutaneous nerve injury.Twenty-six patients were followed up from 6 to 12 months with an average of (9.12±2.06) months.HVA,IMA were (30.01± 3.71)°,(14.00±1.50)° before operation and (9.41±4.16)°,(7.00±0.60)° after operation,which had significant difference.There was statistical significance in AOFAS score before operation 54.77±9.59 and after operation 92.73±5.47,and 19 cases obtained excellent results and 7 moderate.Conclusion:Modified Chevron osteotomy combined with full thread headless pressure screw fixation and lateral tissue loosening for the treatment of mild-moderate hallux valgus has advantages of excellent exposure,simple operation,stable fixation,rapid recovery.Akin osteotomy with internal capsulorrhaphy were used with lateral loosening and could recover soft tissue balance between lateral and internal,and could receive satisfied clinical effects.