Akin联合Chevron截骨术与Akin联合Scarf截骨术矫正拇外翻疗效对比

摘要

Objective To compare the clinical efficacy of Akin combined with Chevron osteotomy with Akin combined with Scarf osteotomy for the correction of hallux valgus. Methods 40 cases of patients (80 feet) with moderate-to-severe hallux valgus deformity treated in our hospital from March 2015 to October 2016 were selected for the study, and divided into the observation group (n=22, with 44 feet, given Akin osteotomy and Chevron osteotomy) and the control group (n=18, with 36 feet, given Akin osteotomy and Scarf osteotomy) according to the different treatment methods. Follow-up of 1 years after operation, and the efficacy was assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) standard, and the visual analogue scale (VAS) was used to assess the callosum pain degree within 2 months after operation, and the hallux valgus angle (HVA), the first and second intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) and AOFAS score were compared between the two groups before and after operation, and the patient satisfaction was compared, and the occurrence of complications was recorded. Results The good rate of deformity correction in the observation group was 93.18％, which was lower than 94.44％ of the control group, and the difference was not statistically significant(P>0.05). The scores of VAS[(2.10 + 0.30) and (1.25 + 0.18)] in the observation group after 1 and 2 months was significantly lower than that of the control group [(3.45 + 0.41) and (2.67 + 0.34)], the difference was statistically significant (P<0.01). There was no significant difference in HVA, IMA and DMAA among the two groups after 1 years of operation(P>0.05). There was no significant difference in AOFAS scores between the two groups after the operation(P>0.05). The satisfaction of the patients in the observation group was higher than that of the control group(P<0.01). There were no serious complications in the two groups. Conclusion Akin and Chevron osteotomy has the similar efficacy with Akin and Scarf osteotomy in the treatment of moderate-to-severe HV patients, but the former one has low pain degree within 2 months after operation with good patient satisfaction, therefore it is suitable for clinical promotion and application.%目的:比较Akin联合Chevron截骨术与Akin联合Scarf截骨术矫正拇外翻的临床疗效.方法:选取2015年3月-2016年10月本院收治的中重度拇外翻畸形患者40例(80只病足)为研究对象,依据治疗方式不同将其分为观察组(Akin+Chevron截骨术,22例,44足)和对照组(Akin+Scarf截骨术,18例,36足),术后随访1年,参照美国矫形足踝协会(AOFAS)评分标准评定疗效,采用疼痛视觉模拟评分(Visual analogue scale,VAS)评估两组术后2个月内胼胝疼痛度,比较两组术前、术后拇外翻角(Hallux valgus angle,HVA)、第一二跖骨间角(Intermetatarsal angle,IMA)及远端关节面固有角(Distal metatarsal articular angle,DMAA),对比患者术后满意度,并记录并发症发生情况.结果:观察组患者畸形矫正优良率为93.18％,低于对照组的94.44％,差异无统计学意义(P>0.05);观察组术后1、2个月VAS评分为[(2.10±0.30)分、(1.25±0.18)分]明显低于对照组的[(3.45±0.41)分、(2.67±0.34)分],差异有统计学意义(P<0.01);术后1年,两组间HVA、IMA、DMAA比较,差异均无统计学意义(P>0.05);术后两组间AOFAS评分比较,差异无统计学意义(P>0.05);观察组患者手术满意度高于对照组,差异有统计学意义(P<0.01).术后随访1年,两组患者均未见严重并发症.结论:Akin+Chevron截骨术与Akin+Scarf截骨术治疗中重度HV患者疗效相似,但前者术后2个月内疼痛度低,患者满意度好,值得在临床推广应用.