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；收肌切斷術

1　對象與方法

圖1　改良Chevron截骨術

1.4術后處理術后關節(jié)進行制動，傷口處繃帶包扎，為防止手術部位感染，可靜脈給予抗生素預防性治療，復查X線片，觀察手術部位關節(jié)愈合和恢復情況。術后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關節(jié)負重，術后35～42 d可正常穿鞋活動。

1.5評價指標比較術前及末次隨訪時影像學資料，對比觀察手術前后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　　果

圖2　改良Chevron截骨術X線片

項目術前術后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：與術前比較，①P<0.05

3　討　　論

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

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

[1]Weil L J, Weil L S. Osteotomies for bunionette deformity [J]. Foot Ankle Clin,2011, 16(4): 689-712.

[2]王正義.足踝外科手術學[M].北京: 人民衛(wèi)生出版社, 2009: 42.

[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.

[4]Jensen M P, McFarland C A. Increasing the reliability and validity of pain intensity measurement in chronic pain patients [J]. Pain, 1993, 55(2): 195-203.

[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)院關節(jié)四肢科

左進步，E-mail: zjbjinbu@sina.com

R684.2