Resch S, Stenström A, Gustafson T
Department of Orthopaedics, University Hospital, Lund, Sweden.
Foot Ankle. 1992 Mar-Apr;13(3):137-42. doi: 10.1177/107110079201300305.
Distal osteotomies, such as Chevron osteotomies, have a potentially high risk for circulatory disturbance, since they transect part of the circulatory apparatus. An increased risk of up to 40% of avascular necrosis diagnosed radiographically has been reported when the osteotomy is combined with adductor tenotomy. On the other hand, new circulatory studies indicate that the circulation does not go in direct proximity to the adductor tendon. In this prospective study, 38 consecutive patients (41 feet) were randomized to Chevron osteotomy alone or Chevron osteotomy with adductor tenotomy. They were investigated 2 to 9 days postoperatively with 99mTc-methylene diphosphonate scintigraphy as well as x-rays and clinical examination. The average follow up was 19 months (range 12-48 months). Three defects were found in those operated with Chevron osteotomy alone, and one defect was found in a patient operated with Chevron osteotomy and adductor tenotomy. None of the patients had symptoms attributable to reduced circulation of the metatarsal head. Repeat scans showed healing in all four cases. Radiographs failed to show any signs of necrosis. Thus, Chevron osteotomy is a safe method in the treatment of hallux valgus which can be combined with adductor tenotomy without increasing the risk for circulatory disturbance.
远端截骨术，如契形截骨术，由于切断了部分循环系统，存在较高的循环障碍风险。据报道，当截骨术与内收肌切断术联合进行时，影像学诊断的无血管坏死风险增加高达40%。另一方面，新的循环研究表明，循环并不直接靠近内收肌腱。在这项前瞻性研究中，38例连续患者（41足）被随机分为单纯契形截骨术组或契形截骨术加内收肌切断术组。术后2至9天，对他们进行了99mTc-亚甲基二膦酸盐闪烁扫描以及X线检查和临床检查。平均随访时间为19个月（范围12至48个月）。单纯契形截骨术患者中发现3处缺损，契形截骨术加内收肌切断术患者中发现1处缺损。所有患者均无因跖骨头循环减少所致的症状。重复扫描显示所有4例均愈合。X线片未显示任何坏死迹象。因此，契形截骨术是治疗拇外翻的一种安全方法，可与内收肌切断术联合使用，而不会增加循环障碍的风险。
