改良撬棒辅助微创Chevron截骨治疗[母]外翻  

Modified crowbar-assisted minimally invasive Chevron osteotomy for the treatment of hallux valgus

作　　者：滕兆麟 耿翔 陈立 张超 黄加张 王旭 马昕 Teng Zhaolin;Geng Xiang;Chen Li;Zhang Chao;Huang Jiazhang;Wang Xu;Ma Xin(Department of Orthopaedics,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《中华骨科杂志》2025年第3期137-143,共7页Chinese Journal of Orthopaedics

摘　　要：目的观察改良撬棒辅助微创Chevron截骨治疗[母]外翻的临床疗效。方法回顾性分析2019年1月至2022年7月因外翻于复旦大学附属华山医院行改良撬棒辅助微创Chevron截骨的42例外翻患者的资料。男3例、女39例,年龄(42.3±8.7)岁(范围26~60岁);左侧18例、右侧24例,体质指数(22.9±2.3)kg/m^(2)。根据外翻角(hallux valgus angle,HVA)大小分为轻度组(15°≤HVA<20°)26例和中度组(20°≤HVA≤40°)16例,均采用改良撬棒辅助Chevron截骨治疗。比较两组手术前后HVA、跖骨间角(intermetatarsal angle,IMA)、第一跖骨远端关节面角(distal metatarsal articular angle,DMAA)、疼痛视觉模拟评分(visual analogue scale,VAS)及美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)趾-跖趾关节评分。结果所有患者均顺利完成手术并获得随访,随访时间为(22.3±6.5)个月(范围18~30个月)。轻度组末次随访时HVA、IMA、DMAA分别为6.6°±1.8°、8.1°±1.8°、4.3°±1.1°,均小于术前的17.8°±1.4°、12.5°±1.5°、7.6°±2.4°,差异有统计学意义(P<0.05)。中度组末次随访时HVA、IMA、DMAA分别为7.6°±2.1°、8.8°±1.6°、4.8°±2.9°,均小于术前的32.3°±3.5°、14.8°±3.5°、12.7°±5.4°,差异有统计学意义(P<0.05)。末次随访时两组HVA、IMA、DMAA组间比较差异无统计学意义(P>0.05)。中度组手术前后HVA、IMA、DMAA差值分别为24.7°±2.6°、6.0°±2.3°、7.9°±3.8°,均大于轻度组的11.2°±1.7°、4.4°±1.6°、3.3°±1.6°,差异有统计学意义(P<0.05)。末次随访时轻度组VAS评分由术前(2.6±2.0)分降至(0.4±0.2)分,差异有统计学意义(t=6.014,P<0.001),中度组由术前的(3.2±2.2)分降至(0.4±0.3)分,差异有统计学意义(t=8.777,P<0.001);轻度组和中度组术前AOFAS趾-跖趾关节评分分别为(71.6±5.9)分和(64.3±7.8)分,末次随访时增加至(93.3±6.0)分和(92.3±6.0)分,差异有统计学意义(P<0.05);末次随访时两组AOFAS趾-跖趾关节评分组�Objective To observe the clinical efficacy of the modified crowbar-assisted minimally invasive Chevron osteotomy for the treatment of hallux valgus.MethodsA total of 42 patients with hallux valgus who underwent modified crowbar-assisted minimally invasive Chevron osteotomy at Huashan Hospital of Fudan University for hallux valgus from January 2019 to July 2022 were retrospectively analyzed.There were 3 males and 39 females,aged 42.3±8.7 years(range,26-60 years);18 left-sided and 24 right-sided,with body mass index 22.9±2.3 kg/m^(2).According to the size of the hallux valgus angle(HVA),26 patients were divided into the mild group(15°≤HVA<20°)and 16 patients were divided into moderate group(20°≤HVA≤40°).All patients were treated with modified crowbar-assisted Chevron osteotomy.The preoperative and postoperative HVA,intermetatarsal angle(IMA),distal metatarsal articular angle(DMAA),visual analogue scale(VAS)and American Orthopaedic Foot and Ankle Society metatarsophalangeal interphalangeal scale(AOFAS Hallux MTP-IP scale)were compared.ResultsAll patients successfully completed the operation and were followed up for an average of 22.3±6.5 months(range,18-30 months).The HVA,IMA,and DMAA in the mild group at the last follow-up were 6.6°±1.8°,8.1°±1.8°,and 4.3°±1.1°,respectively,which were significantly lower than those before operation 17.8°±1.4°,12.5°±1.5°,and 7.6°±2.4°(P<0.05).The HVA,IMA,and DMAA in the moderate group at the last follow-up were 7.6°±2.1°,8.8°±1.6°,and 4.8°±2.9°,respectively,which were significantly lower than those before operation 32.3°±3.5°,14.8°±3.5°,and 12.7°±5.4°(P<0.05).At the last follow-up,there was no significant difference in HVA,IMA,or DMAA between the two groups(P>0.05).The differences of HVA,IMA,and DMAA before and after operation in the moderate group were 24.7°±2.6°,6.0°±2.3°,and 7.9°±3.8°,respectively,which were greater than those in the mild group 11.2°±1.7°,4.4°±1.6°,and 3.3°±1.6°,and the differences were statistica

关 键 词：[母]外翻 截骨术 最小侵入性外科手术 

分 类 号：R687.3[医药卫生—骨科学]