Choi K J, Lee H S, Yoon Y S, Park S S, Kim J S, Jeong J J, Choi Y R
Choi Kyung Jin Orthopaedic Hospital, 369-26 Woobong Building 3F, Shindang-dong, Jung-gu, Seoul, Korea.
J Bone Joint Surg Br. 2011 Aug;93(8):1079-83. doi: 10.1302/0301-620X.93B8.26430.
We reviewed the outcome of distal chevron metatarsal osteotomy without tendon transfer in 19 consecutive patients (19 feet) with a hallux varus deformity following surgery for hallux valgus. All patients underwent distal chevron metatarsal osteotomy with medial displacement and a medial closing wedge osteotomy along with a medial capsular release. The mean hallux valgus angle improved from -11.6° pre-operatively to 4.7° postoperatively, the mean first-second intermetatarsal angle improved from -0.3° to 3.3° and the distal metatarsal articular angle from 9.5° to 2.3° and the first metatarsophalangeal joints became congruent post-operatively in all 19 feet. The mean relative length ratio of the metatarsus decreased from 1.01 to 0.99 and the mean American Orthopaedic Foot and Ankle Society score improved from 77 to 95 points. In two patients the hallux varus recurred. One was symptom-free but the other remained symptomatic after a repeat distal chevron osteotomy. There were no other complications. We consider that distal chevron metatarsal osteotomy with a medial wedge osteotomy and medial capsular release is a useful procedure for the correction of hallux varus after surgery for hallux valgus.
我们回顾了19例（19足）拇外翻手术后出现拇内翻畸形且未行肌腱转移的患者接受远端V形截骨术的治疗结果。所有患者均接受了远端V形截骨术，包括内侧移位和内侧闭合楔形截骨以及内侧关节囊松解术。拇外翻平均角度从术前的-11.6°改善至术后的4.7°，第一、二跖骨间平均角度从-0.3°改善至3.3°，远端跖骨关节角从9.5°改善至2.3°，并且所有19足的第一跖趾关节术后均恢复了正常对合关系。跖骨平均相对长度比从1.01降至0.99，美国矫形足踝协会平均评分从77分提高至95分。2例患者拇内翻复发。1例无症状，另1例在再次行远端V形截骨术后仍有症状。未出现其他并发症。我们认为，远端V形截骨术联合内侧楔形截骨术及内侧关节囊松解术是矫正拇外翻手术后拇内翻的有效方法。
