第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻  

Distal Chevron osteotomy of the first metatarsal and soft tissue release for hallux valgus

作　　者：范东华 邢润麟 王培民[1] 梅伟[1] 黄正泉[1] 张立[1] 丁亮[1] 茆军[1] FAN Dong-hua;XING Run-lin;WANG Pei-min;MEI Wei;HUANG Zheng-quan;ZHANG Li;DING Liang;MAO Jun(The Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京中医药大学附属医院,江苏南京210029

出　　处：《中国骨伤》2019年第1期64-67,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的 :探讨第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻的临床疗效。方法:自2015年6月至2017年6月,采用第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻32例(40足),其中男3例3足,女29例37足;年龄22～80岁,平均57.57岁;病程2～32年,平均14年;轻度9足,中度31足。术前患者合并拇囊炎,伴有第1跖趾关节周围疼痛并存在负重行走时疼痛加重。手术前后拍摄足负重正侧位片,比较拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),并采用美国足踝外科协会拇外翻评分(AOFAS)评价临床疗效。结果:32例患者获得了随访,时间12～24个月,平均15.2个月。术后切口均愈合良好,无感染、跖骨头坏死等并发症发生。术前HVA、IMA分别由(32.08±5.59)°、(11.63±2.24)°减小至术后12个月的(10.31±4.36)°、(5.02±2.34)°,差异有统计学意义(P<0.05)。AOFAS评分由术前的56.75±6.42提高至术后12个月的88.80±3.99 (P<0.05)。结论:第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻畸形可获得较好的临床效果,为拇外翻治疗提供了更多的选择。Objective:To explore distal Chevron osteotomy of the first metatarsal and soft-tissue release for the treatment of mild and moderate hallux valgus.Methods:From June 2015 to June 2017,32 patients(40 feet)with mild and moderate hallux valgus were treated with distal Chevron osteotomy with soft tissue release.including 3 males(3 feet)and 29 females(37 feet),aged from 22 to 80 years old with an average of 57.57 years old.The courses of disease ranged from 2 to 32 years with an average of 14 years.Among them,9 feet were mild,31 feet were moderate.Patients were combined with bunion,pain around the first metatarsal joint,and pain increased during weight-bearing walking before opertaion.AP and lateral X-rays on weight-bearing were performed,hallux valgus angle(HVA)and intermetatarsal angle(IMA)between the first and the second metatarsal were examined before and after operation.AOFAS score was applied to evaluate clinical effects.Results:All patients were followed up from 12 to 24 months with an average of 15.2 months.Fracture wounds were healed well without infection and metatarsal head necrosis occurred.Preoperative HVA(32.08±5.59)°and IMA(11.63±2.24)°decreased to(10.31±4.36)°and(5.02°±2.34)°after operation at 12 months,and had statistical difference before and after operation(P<0.05).AOFAS score increased from 56.75±6.42 before operation to 88.80±3.99 after operation at 12 months(P<0.05).Conclusion:Distal Chevron osteotomy of the first metatarsal and soft-tissue release for the treatment of mild and moderate hallux valgus could obtain good effects and provide more options for hallux valgus treatment.

关 键 词：拇外翻 截骨术 跖骨 

分 类 号：R628.6[医药卫生—整形外科]