改良Chevron截骨术治疗青少年踇外翻的疗效分析
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摘要
目的分析改良Chevron截骨术治疗青少年踇外翻的临床疗效。方法 2011-01/2017-12月,四川省骨科医院共收治青少年踇外翻23例(34足),男性7例(9足),女性16例(25足);年龄10~16岁,平均14.6岁。其中5例(8足)合并平足,10例(13足)合并腓肠肌紧张。对所有患者进行改良Chevron截骨,腓肠肌松解术,截骨后使用3mm无头加压螺钉固定。术前、术后在X线片上测量负重位踇外翻角(hallux valgus angle,HVA)、第一、二跖间角(intermetatarsal angle,IMA)、第一跖骨远端关节面固有角(distal metatarsal articular angle,DMAA)、胫侧籽骨位置分级,并采用美国足踝外科协会(American Orthopedic Foot Ankle Society,AOFAS)前足评分系统对所有患者进行术前、术后功能评估,采用视觉模拟评分(visual analogue score,VAS)系统对术前、术后疼痛进行评价。结果 23例(34足)随访21例(32足),随访时间24~72个月,平均30.7个月,均获得骨性愈合。术后外观满意,无踇内翻、转移性跖骨痛及畸形复发并发症。其中合并平足患者,术后经过足垫辅助无力线异常。经腓肠肌松解的患者术后下肢肌力正常。患者术前与术后IMA1-2、HVA、AOFAS(前足)、VAS评分比较均有统计学差异(P<0.05或0.01)。结论改良Chevron截骨术治疗青少年踇外翻,效果满意,临床疗效优良。
Objective To analyze the clinical effect of modified Chevron osteotomy in the treatment of adolescent hallux valgus.Methods From January 2011 to December 2017,23 cases(34 feet)of adolescent hallus valgus were treated in authorshospital,including 7 male cases(9 feet),16 female cases(25 feet),10 to 16 years old,averaged 14.6 years.Among them,5 cases(8 feet)were flat foot,10 cases(13 feet)were gastrocnemius muscle tension.All patients were treated with modified Chevron osteotomy,gastrocnemius release,and then fixed it with 3 mm headless compression screw after osteotomy.Before and after operation,the hallux valgus angle(HVA),the first and second intermetatarsal angle(IMA),first distal metatarsal articular angle(DMAA),tibial seed bone position classification in weight bearing position were measured.The preoperative and postoperative functional evaluations and pain degrees of all patients were performed by fore foot scoring system of American Orthopedic Foot Ankle Society(AOFAS)and evaluated by visual analogue score(VAS)system,respectively.Results Among 23 cases(34 feet),21 cases(32 feet)were followed up,follow-up time was24-72 months(mean 30.7 months),and all patients were bone healing.Postoperative appearance was satisfactory.No hallux varus,metastatic metatarsal pain and deformity recurred.The patients who complicated with flat foot had no abnormal line after using the foot pad.The muscle strength of lower extremity was normal after gastrocnemius release.There were significantly different in the IMA 1-2,HVA,AOFAS(fore foot),VAS scores before and after operation(P<0.05 or0.01).Conclusion Modified Chevron osteotomy in the treatment of adolescent hallux valgus have a satisfactory clinical effect.
Objective To analyze the clinical effect of modified Chevron osteotomy in the treatment of adolescent hallux valgus.Methods From January 2011 to December 2017,23 cases(34 feet)of adolescent hallus valgus were treated in authorshospital,including 7 male cases(9 feet),16 female cases(25 feet),10 to 16 years old,averaged 14.6 years.Among them,5 cases(8 feet)were flat foot,10 cases(13 feet)were gastrocnemius muscle tension.All patients were treated with modified Chevron osteotomy,gastrocnemius release,and then fixed it with 3 mm headless compression screw after osteotomy.Before and after operation,the hallux valgus angle(HVA),the first and second intermetatarsal angle(IMA),first distal metatarsal articular angle(DMAA),tibial seed bone position classification in weight bearing position were measured.The preoperative and postoperative functional evaluations and pain degrees of all patients were performed by fore foot scoring system of American Orthopedic Foot Ankle Society(AOFAS)and evaluated by visual analogue score(VAS)system,respectively.Results Among 23 cases(34 feet),21 cases(32 feet)were followed up,follow-up time was24-72 months(mean 30.7 months),and all patients were bone healing.Postoperative appearance was satisfactory.No hallux varus,metastatic metatarsal pain and deformity recurred.The patients who complicated with flat foot had no abnormal line after using the foot pad.The muscle strength of lower extremity was normal after gastrocnemius release.There were significantly different in the IMA 1-2,HVA,AOFAS(fore foot),VAS scores before and after operation(P<0.05 or0.01).Conclusion Modified Chevron osteotomy in the treatment of adolescent hallux valgus have a satisfactory clinical effect.
引文
[1]Raikin SM,Miller AG,Daniel J.Recurrence of Hallux Valgus[J].Foot Ankle Clin,2014,19(2):259-274
[2]Koo KK,Tse LF,Cheng HS,et al.The progression of hallux valgus in the oriental Chinese population in Hong Kong[J].Foot(Edinb),2017,32:15-21
[3]Anderson M,Blais MM,Green WT.Lengths of the growing foot[J].J Bone Joint Surg Am,1956,38-A(5):998-1000
[4]Lechler P,Feldmann C,K9ck FX,et al.Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure:aprospective matched group analysis[J].Arch Orthop Trauma Surg,2011,132(1):9-13
[5]Okuda R,Yasuda T,Jotoku T,et al.Proximal abduction-supination osteotomy of the first metatarsal for adolescent hallux valgus:apreliminary report[J].J Orthop Sci,2013,18(3):419-425
[6]Young KW,Kim JS,Cho JW,et al.Characteristics of male adolescent-onset hallux valgus[J].Foot Ankle Int,2013,34(8):1111-1116
[7]Luba R,Rosman M.Bunions in children:treatment with a modified Mitchell osteotomy[J].J Pediatr Orthop,1984,4(1):44-47
[8]Lowery NJ,Wukich DK.Adolescent Hallux Valgus:evaluation and treatment[J].Oper Tech Orthop,2017,27(1):63-69
[9]Zimmer TJ,Johnson KA,Klassen RA.Treatment of hallux valgus in adolescents by the Chevron osteotomy[J].Foot Ankle,1989,9(4):190-193
[10]McCluney JG,Tinley P.Radiographic measurements of patients with juvenile hallux valgus compared with age-matched controls:a cohort investigation[J].J Foot Ankle Surg,2006,45(3):161-167
[11]Sanhudo JA.Correction of moderate to severe hallux valgus deformity by a modified chevron shaft osteotomy[J].Foot Ankle Int,2006,27(8):581-585
[12]Farrar NG,Duncan N,Ahmed N,et al.Scarf osteotomy in the management of symptomatic adolescent hallux valgus[J].J Child Orthop,2012,6(2):153-157
[13]俞光荣,杨晓东,张根福,等.Austin手术治疗青少年踇外翻临床研究[C]//浙江省医学会骨科分会.浙江省骨科学骨科年会论文汇编.浙江:浙江省医学会骨科分会,2015:16
[14]王显军,张建中,毛威.Chevron截骨术治疗踇外翻临床疗效观察[C]//中华医学会.第十四届全国足踝外科学术大会论文集.北京:人民卫生出版社,2011:143
[15]Trnka HJ,Zembsch A,Easley ME,et al.The Chevron osteotomy for correction of halluxvalgus.Comparison of findings after two and five years of follow-up[J].J Bone Joint Surg Am,2000,82-A(10):1373-1378
[16]Schneider W,Aigner N,Pinggera O,et al.Chevron osteotomy in hallux valgus:ten-year results of 112cases[J].J Bone Joint Surg Br,2004:86(7):1016-1020
[17]孙亚宁,张晓婵,唐钰超,等.联合截骨治疗青少年踇外翻的临床疗效分析[J].足踝外科电子杂志,2015,2(4):11-15
[2]Koo KK,Tse LF,Cheng HS,et al.The progression of hallux valgus in the oriental Chinese population in Hong Kong[J].Foot(Edinb),2017,32:15-21
[3]Anderson M,Blais MM,Green WT.Lengths of the growing foot[J].J Bone Joint Surg Am,1956,38-A(5):998-1000
[4]Lechler P,Feldmann C,K9ck FX,et al.Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure:aprospective matched group analysis[J].Arch Orthop Trauma Surg,2011,132(1):9-13
[5]Okuda R,Yasuda T,Jotoku T,et al.Proximal abduction-supination osteotomy of the first metatarsal for adolescent hallux valgus:apreliminary report[J].J Orthop Sci,2013,18(3):419-425
[6]Young KW,Kim JS,Cho JW,et al.Characteristics of male adolescent-onset hallux valgus[J].Foot Ankle Int,2013,34(8):1111-1116
[7]Luba R,Rosman M.Bunions in children:treatment with a modified Mitchell osteotomy[J].J Pediatr Orthop,1984,4(1):44-47
[8]Lowery NJ,Wukich DK.Adolescent Hallux Valgus:evaluation and treatment[J].Oper Tech Orthop,2017,27(1):63-69
[9]Zimmer TJ,Johnson KA,Klassen RA.Treatment of hallux valgus in adolescents by the Chevron osteotomy[J].Foot Ankle,1989,9(4):190-193
[10]McCluney JG,Tinley P.Radiographic measurements of patients with juvenile hallux valgus compared with age-matched controls:a cohort investigation[J].J Foot Ankle Surg,2006,45(3):161-167
[11]Sanhudo JA.Correction of moderate to severe hallux valgus deformity by a modified chevron shaft osteotomy[J].Foot Ankle Int,2006,27(8):581-585
[12]Farrar NG,Duncan N,Ahmed N,et al.Scarf osteotomy in the management of symptomatic adolescent hallux valgus[J].J Child Orthop,2012,6(2):153-157
[13]俞光荣,杨晓东,张根福,等.Austin手术治疗青少年踇外翻临床研究[C]//浙江省医学会骨科分会.浙江省骨科学骨科年会论文汇编.浙江:浙江省医学会骨科分会,2015:16
[14]王显军,张建中,毛威.Chevron截骨术治疗踇外翻临床疗效观察[C]//中华医学会.第十四届全国足踝外科学术大会论文集.北京:人民卫生出版社,2011:143
[15]Trnka HJ,Zembsch A,Easley ME,et al.The Chevron osteotomy for correction of halluxvalgus.Comparison of findings after two and five years of follow-up[J].J Bone Joint Surg Am,2000,82-A(10):1373-1378
[16]Schneider W,Aigner N,Pinggera O,et al.Chevron osteotomy in hallux valgus:ten-year results of 112cases[J].J Bone Joint Surg Br,2004:86(7):1016-1020
[17]孙亚宁,张晓婵,唐钰超,等.联合截骨治疗青少年踇外翻的临床疗效分析[J].足踝外科电子杂志,2015,2(4):11-15