Chevron-Akin截骨可吸收螺钉固定治疗重度[母]外翻的早期临床疗效  

Early clinical outcomes of Chevron-Akin osteotomy with absorbable screw fixation for the treatment of severe hallux valgus deformity

作　　者：杨勤梦 王晓康 侯辉歌[2] 洪劲松 Yang Qinmeng;Wang Xiaokang;Hou Huige;Hong Jinsong(Department of Foot and Ankle Surgery,Guangzhou Orthopaedic Hospital,Guangzhou 510045,China;Department of Foot and Ankle Surgery,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China;Department of Foot and Ankle Surgery,the First Affiliated Hospital of Jinan University)

机构地区：[1]广州市正骨医院足踝外科,广州510045 [2]暨南大学附属第一医院足踝外科,广州510630 [3]暨南大学附属第一医院足踝外科

出　　处：《中华骨科杂志》2025年第3期159-165,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨Chevron-Akin截骨可吸收螺钉内固定治疗重度[母]外翻畸形的早期临床疗效。方法回顾性收集2022年1月至2023年1月于广州市正骨医院收治的接受微创Chevron-Akin截骨术可吸收螺钉固定治疗的35例重度[母]外翻患者资料,男2例、女33例,年龄(56.75±13.27)岁(范围20~72岁),左侧18例、右侧17例。收集并分析患者术前及术后12个月的影像学和临床评估数据,记录随访期间发生的并发症。影像学资料包括足负重X线片测量的外翻角(hallux valgus angle,HVA)和第一、二跖骨间角(intermetatarsal angle,IMA);临床评估包括采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)趾关节评分系统和疼痛视觉模拟评分(visual analogue scale,VAS)对患者的功能和疼痛进行评估。结果35例均顺利完成手术,手术时间为(61.5±3.2)min,术中出血量为(5.4±1.2)ml;随访时间为(15.65±2.48)个月。末次随访时AOFAS评分由术前的(39.8±4.7)分提高至(92.3±4.1)分、VAS由(8.7±1.2)分降低至(1.8±0.8)分、HVA由42.5°±4.1°降至12.5°±3.7°、IMA由18.5°±2.8°降至7.3°±2.1°,差异均有统计学意义(P<0.05)。7例合并腓肠肌紧张的患者联合实施腓肠肌松解术;11例伴随转移性跖痛的患者中,8例行Weil截骨术、3例行跖骨头成形术,均获得良好疗效。35例截骨端均获得骨性愈合,未出现骨不连或移位等严重并发症。2例于术后第3天出现切口周围皮肤麻木的情况,均于术后3个月时症状消失。结论Chevron-Akin截骨可吸收螺钉固定治疗重度[母]外翻畸形能够改善患者的早期临床功能及症状,并发症发生率较低,是一种安全有效的手术方式。Objective To evaluate the short-term clinical outcomes of minimally invasive surgery for severe hallux valgus deformity using absorbable screw fixation.MethodsThis retrospective study included 35 patients with severe hallux valgus deformities treated with third-generation minimally invasive Chevron and Akin osteotomies(MICA)using absorbable screws at the Foot and Ankle Surgery Department of Guangzhou Orthopedic Hospital from January 2022 to January 2023.The cohort consisted of 2 males and 33 females,with an average age of 56.75±13.27 years(ranging from 20 to 72 years).There were 18 cases of left foot and 17 of right.Preoperative and 12-month postoperative radiographic and clinical data were collected and analyzed.Radiographic evaluations included measurements of the hallux valgus angle(HVA)and intermetatarsal angle(IMA)on weight-bearing foot X-ray films.Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society(AOFAS)hallux metatarsophalangeal-interphalangeal scale and the visual analogue scale(VAS)for pain.All complications during follow-up were recorded to comprehensively assess surgical outcomes and safety.ResultsAll the 35 cases successfully underwent the surgery,with a surgery time of 61.5±3.2 minutes and intraoperative blood loss of 5.4±1.2 ml.No patients lost follow-up,with a mean follow-up of 15.65±2.48 months(ranging from12 to 19 months).At the final follow-up,the AOFAS score significantly improved from 39.8±4.7 preoperatively to 92.3±4.1 postoperatively(P<0.05),and the VAS significantly decreased from 8.7±1.2 to 1.8±0.8(P<0.05).The HVA decreased from 42.5°±4.1°to 12.5°±3.7°(P<0.05),and the IMA decreased from 18.5°±2.8°to 7.3°±2.1°(P<0.05).Radiographic follow-up demonstrated complete osseous union at the osteotomy sites in all cases,with no complications of nonunion or displacement.7 patients with concurrent gastrocnemius tightness underwent gastrocnemius release,and 11 patients with associated transfer metatarsalgia were treated with Weil osteotomy(n=8)or m

关 键 词：[母]外翻 最小侵入性外科手术 可吸收性植入物 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]