Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser Karl V Allee 3, 93077 Bad Abbach, Germany.
Arch Orthop Trauma Surg. 2012 Jan;132(1):9-13. doi: 10.1007/s00402-011-1385-3. Epub 2011 Aug 28.
Hallux valgus is a frequent condition of the forefoot, resulting in cosmetic deformity and pain. Chevron osteotomy (CO) is widely employed for the treatment of hallux valgus. Chevron-Akin double osteotomy (CAO) was previously described and superiority over an isolated Chevron procedure was assumed. The objective of this study was to compare the short-to-middle term outcomes of CO and CAO.
This study included 72 patients with established diagnosis of mild-to-moderate hallux valgus, treated by either isolated CO or CAO. The CO group included 46 patients (mean 51.5 years) with a mean hallux valgus angle of 27°, while the CAO group included 26 subjects (mean 53.1 years) and a mean hallux valgus angle of 32° preoperatively. All patients were reviewed by physical examination, and standardized questionnaire, and pre- and postoperative standing X-rays were performed. Matched group analysis was carried out to analyze statistical differences of both techniques.
The patients were assessed and group matched at a mean of 1.37 years for the CO group and 1.04 years for the CAO group, postoperatively. Mean improvement of HVA (hallux valgus angle) was 10.6° in the CO group and the CAO group improved by 17.5°. DMAA (distal metatarsal articular angle) improved in the CO group by 5.4° and in the CAO by 13.7°. Mean AOFAS score improved by 27.9 (CO) and 21.5 (CAO). Patient satisfaction was high in both groups, with a tendency towards higher values within the CAO group.
These findings indicate that Chevron-Akin double osteotomy is a save and practicable procedure for the treatment of mild-to-moderate hallux valgus. Superiority of combined Chevron-Akin procedure over an isolated Chevron osteotomy might be limited to distinct clinical settings, but should not be generally assumed.
拇外翻是一种常见的前足疾病，导致外观畸形和疼痛。Chevron 截骨术（CO）广泛用于治疗拇外翻。Chevron-Akin 双截骨术（CAO）先前已有描述，并假定其优于单纯的 Chevron 手术。本研究的目的是比较 CO 和 CAO 的短期至中期结果。
本研究纳入了 72 例确诊为轻度至中度拇外翻的患者，分别接受单纯 CO 或 CAO 治疗。CO 组包括 46 例患者（平均年龄 51.5 岁），平均拇外翻角为 27°，而 CAO 组包括 26 例患者（平均年龄 53.1 岁），术前平均拇外翻角为 32°。所有患者均通过体格检查和标准化问卷进行评估，并进行术前和术后站立位 X 线检查。进行匹配组分析以分析两种技术的统计学差异。
CO 组和 CAO 组的平均随访时间分别为 1.37 年和 1.04 年。CO 组的 HVA（拇外翻角）平均改善 10.6°，CAO 组改善 17.5°。CO 组 DMAA（远端跖骨关节角）改善 5.4°，CAO 组改善 13.7°。CO 组 AOFAS 评分平均改善 27.9，CAO 组改善 21.5。两组患者满意度均较高，CAO 组的满意度有升高趋势。
这些发现表明 Chevron-Akin 双截骨术是治疗轻度至中度拇外翻的一种安全可行的方法。联合 Chevron-Akin 手术优于单纯 Chevron 截骨术的优势可能仅限于特定的临床环境，但不应一概而论。
