[母]外翻改良Chevron手术后复发的危险因素分析  

Analysis of risk factors for recurrence after modified Chevron osteotomy for hallux valgus

作　　者：孙宁 杨晓松 赖良鹏 李兴 李文菁 李恒 李莹 武勇 Sun Ning;Yang Xiaosong;Lai Liangpeng;Li Xing;Li Wenjing;Li Heng;Li Ying;Wu Yong(Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院足踝外科,北京100035

出　　处：《中华骨科杂志》2025年第3期180-186,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨[母]外翻改良Chevron手术后复发的危险因素。方法回顾性分析2018年12月至2021年2月因外翻于北京积水潭医院接受改良Chevron手术治疗的86例(102足)患者资料,男12例(14足)、女74例(88足),年龄(50±15)岁(范围18~74岁)。右侧36例、左侧34例、双侧16例。单纯行Chevron手术4足、联合改良McBride术74足、联合Weil截骨术61足、联合Akin截骨术24足、联合腓肠肌腱膜松解术23足。末次随访时外翻角(hallux valgus angle,HVA)≤15°定义为[母]外翻术后未复发组、HVA>15°定义为[母]外翻术后复发组。比较两组患者年龄、性别、术前HVA、手术前后第一、二跖骨间角(intermetatarsal angle,IMA)、手术前后跖骨内收角(metatarsus adductus angle,MAA)、手术前后Meary角、手术前后跖骨远端关节角(distal metatarsal articular angle,DMAA)、手术前后美国足踝外科协会(Orthopaedic Foot and Ankle Society,AOFAS)前足评分、第一跖骨头旋转。将差异有统计学意义的指标纳入二分类变量logistic回归分析,筛选[母]外翻改良Chevron手术后复发的危险因素。结果所有患者均顺利完成手术并获得随访,随访时间为(30.3±16.4)个月(范围12~52个月)。术后21足出现复发,复发率为20.6%(21/102)。未复发组末次随访的HVA为8.48°±4.52°,复发组为20.68°±3.61°。未复发组末次随访AOFAS踝与后足评分由术前的(60.31±16.62)分增加至术后的(86.89±12.79)分(t=-13.644,P<0.001),复发组末次随访的AOFAS踝与后足评分由术前的(61.71±15.68)分增加至术后的(84.33±18.84)分(t=-6.082,P<0.001)。未复发组术前Meary角>4°的患者比例为52%(10/21),小于复发组的79%(64/81),差异有统计学意义(χ^(2)=6.077,P=0.014);复发组术后跖骨旋转类型为方型(A型)的患者比例为58%(47/81),大于未复发组的33%(7/21),差异有统计学意义(χ^(2)=4.081,P=0.043)。两组患者的性别、年龄、术前HVA、手术前后IMA、手术前后DMAA、手术前后MAA、术前Objective To investigate the risk factors for recurrence after modified Chevron osteotomy for hallux valgus.MethodsA total of 86 patients(102 feet)with hallux valgus who underwent modified Chevron operation in Beijing Jishuitan Hospital from December 2018 to February 2021 were retrospectively analyzed.There were 12 males(14 feet)and 74 females(88 feet),aged 50±15 years(range,18-74 years).There were 36 cases on the right side,34 on the left side,and 16 on the bilateral side.4 feet were treated with Chevron osteotomy,74 feet with modified McBride's osteotomy,61 feet with Weil osteotomy,24 feet with Akin osteotomy,and 23 feet with gastrocnemius aponeurotic release.At the last follow-up,hallux valgus angle(HVA)≤15°was defined as the non-recurrence group after hallux valgus operation,and HVA>15°was defined as the recurrence group after hallux valgus operation.Compare the age,gender,preoperative HVA,the first and second intermetatarsal angles(IMA)before and after operation,the metatarsus adductus angles(MAA)before and after operation,the Meary angles before and after operation,the distal metatarsal articular angles(DMAA)before and after operation,the American Orthopaedic Foot and Ankle Society(AOFAS)forefoot scores before and after operation,and the rotation of the first metatarsal head between the two groups of patients.Include the indicators with statistically significant differences in the binary variable logistic regression analysis to screen for the risk factors of recurrence after modified Chevron operation for hallux valgus.ResultsAll patients successfully completed the operation and were followed up for 30.3±16.4 months(range,12-52 months).Postoperative recurrence occurred in 21 feet,and the recurrence rate was 20.6%(21/102).The HVA at the last follow-up was 8.48°±4.52°in the non-recurrence group and 20.68°±3.61°in the recurrence group.In the non-recurrence group,the AOFAS ankle-hindfoot score increased from 60.31±16.62 points preoperatively to 86.89±12.79 points postoperatively(t=-13.644,P<0.001)

关 键 词：[母]外翻 截骨术 复发 危险因素 

分 类 号：R687.3[医药卫生—骨科学]