Chevron-Akin截骨术空心加压螺钉与可吸收螺钉固定治疗中重度[母]外翻  

Efficacy of Chevron-Akin osteotomy with cannulated compression screw and absorbable screw fixation in the treatment of moderate and severe hallux valgus

作　　者：张宇[1] 王勇[1] 张文举[1] 徐善强 李平[1] 何凯元 曲亭亭 Zhang Yu;Wang Yong;Zhang Wenju;Xu Shanqiang;Li Ping;He Kaiyuan;Qu Tingting(The 2nd Department of Foot and Ankle,Sichuan Provincial Orthopaedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院足踝2科,成都610041

出　　处：《中华骨科杂志》2025年第3期151-158,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨Chevron-Akin截骨术空心加压螺钉与可吸收螺钉固定治疗中重度[母]外翻的临床疗效。方法回顾性分析2020年1月至2022年12月于四川省骨科医院采用Chevron-Akin截骨术和螺钉固定治疗52例中重度[母]外翻患者资料,根据固定方式分为金属螺钉组和可吸收螺钉组。金属螺钉组25例(26足),男2例(2足)、女23例(24足),年龄(36.7±4.9)岁(范围21~59岁),左侧12足、右侧14足,中度20足、重度6足;可吸收螺钉组27例(29足),男1例(1足)、女26例(28足),年龄(34.1±5.5)岁(范围19~56岁),左侧16足、右侧13足,中度22足、重度7足。记录两组患者截骨愈合时间及并发症情况,比较手术前后的外翻角(hallux valgus angle,HVA)、第一、二跖骨间角(first-second intermetatarsal angle,1-2 IMA)、美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)趾-跖趾-趾间关节评分、疼痛视觉模拟评分(visual analogue scale,VAS)。结果52例患者均获得随访,金属螺钉组(14.0±3.4)个月(范围11~27个月)、可吸收螺钉组(15.1±2.7)个月(范围13~24个月)。所有患者切口均一期愈合,无一例出现内固定物排斥反应。金属螺钉组截骨愈合时间为(3.8±0.8)个月(范围2~5个月),可吸收螺钉组为(3.4±1.1)个月(范围2.5~5个月),差异无统计学意义(t=1.014,P=0.417)。金属螺钉组发生第一跖骨内侧内固定物刺激症状2足、内侧骨赘或线结刺激2足、[母]外翻复发1足,并发症发生率为19%(5/26);可吸收螺钉组发生内侧骨赘或线结刺激1足、[母]外翻复发1足,并发症发生率为7%(2/29);两组并发症发生率的差异有统计学意义(χ^(2)=8.051,P=0.012)。术后12个月,金属螺钉组和可吸收螺钉组患者HVA(分别为13.7°±2.1°和12.9°±3.8°)、1-2 IMA(7.2°±1.5°和7.8°±1.2°)、AOFAS评分[(91.4±2.2)分和(90.8±3.6)分]、VAS评分[(1.1±0.3)分和(1.3±0.4)分]均较术前[HVA:37.2°±5.4°和35.8°±4.7°;1-2 IMA:18.3°±1.8°和17.9°±1.7°;AOFAS评分:(60Objective To compare the clinical efficacy of Chevron-Akin osteotomy with cannulated compression screw and absorbable screw fixation in the treatment of moderate and severe hallux valgus.Methods The data of 52 patients with moderate to severe hallux valgus treated in Sichuan Provincial Orthopaedic Hospital from January 2020 to December 2022 were retrospectively analyzed.According to the fixation method,they were divided into metal screw group and absorbable screw group.In the metal screw group,there were 25 cases(26 feet),2 males(2 feet)and 23 females(24 feet),aged 36.7±4.9 years(range,21-59 years),12 feet on the left side,14 feet on the right side,moderate 20 feet and severe 6 feet.There were 27 cases(29 feet)in the absorbable screw group,including 1 male(1 foot)and 26 female(28 feet),aged 34.1±5.5 years(range,19-56 years),16 feet on the left side,13 feet on the right side,moderate 22 feet and severe 7 feet.The healing time and complications of osteotomy were recorded between the two groups,and the hallux valgus angle(HVA),first-second intermetatarsal angle(1-2 IMA),American Orthopaedic Foot and Ankle Society(AOFAS),hallux-metatarsophalangeal-interphalangeal joint score and visual analogue scale(VAS)for pain were compared before and after the operation.ResultsAll 52 patients were followed up.The follow-up time was 14.0±3.4 months(range,11-27 months)in the metal screw group and 15.1±2.7 months(range,13-24 months)in the absorbable screw group.In all patients,the incision healed in one stage,and no endovegetal rejection occurred.The osteotomy healing time was 3.8±0.8 months(range,2-5 months)in the metal screw group and 3.4±1.1 months(range,2.5-5 months)in the absorbable screw group,with no statistically significant difference(t=1.014,P=0.417).In the metal screw group,there were symptoms of medial internal fixation irritation in 2 feet,medial osteophyte or thread knot irritation in 2 feet,and hallux valgus recurrence in 1 foot.The complication rate was 19%(5/26).In the absorbable screw group,medial osteophyte

关 键 词：[母]外翻 截骨术 骨螺丝 最小侵入性外科手术 

分 类 号：R687.3[医药卫生—骨科学]