Jowett Charlie R J, Bedi Harvinder S
Foot and Ankle Fellow, The Alfred Hospital, Melbourne, Victoria, Australia.
Consultant Orthopaedic Surgeon, OrthoSport Victoria, Richmond, Victoria, Australia.
J Foot Ankle Surg. 2017 May-Jun;56(3):445-452. doi: 10.1053/j.jfas.2017.01.002. Epub 2017 Feb 22.
Minimally invasive surgery is increasing in popularity. It is relevant in hallux valgus surgery owing to the potential for reduced disruption of the soft tissues and improved wound healing. We present our results and assess the learning curve of the minimally invasive Chevron Akin operation for hallux valgus. A total of 120 consecutive feet underwent minimally invasive Chevron Akin for symptomatic hallux valgus, of which 14 were excluded. They were followed up for a mean of 25 (range 18 to 38) months. The patients were clinically assessed using the American Orthopaedic Foot and Ankle Society score. Complications and patient satisfaction were recorded. The radiographs were analyzed and measurements recorded for hallux valgus and intermetatarsal angle correction. The mean age of the patients undergoing surgery was 55 (range 25 to 81) years. Of the 78 patients, 76 (97.4%) were female and 2 (2.6%) were male; 28 (35.9%) cases were bilateral. The mean American Orthopaedic Foot and Ankle Society score improved from 56 (range 23 to 76) preoperatively to 87 (range 50 to 100) postoperatively (p < .001). The mean hallux valgus and intermetatarsal angles preoperatively were 29.7° (range 12° to 46°) and 14.0° (range 8° to 20°). The corresponding postoperative angles were 10.3° (range 0° to 25°) and 7.6° (range 3° to 15°; p < .001). The patients were satisfied with the results of surgery in 87% of cases (92 of 106). The incidence of reoperation was 14% (15 of 106). These are the only reported results for this technique. They display a steep associated learning curve. However, the results are promising, and the learning curve is comparable to that for open hallux valgus surgery.
微创手术越来越受欢迎。由于其对软组织的破坏可能减少且伤口愈合得到改善,因此在拇外翻手术中具有重要意义。我们展示了我们的结果,并评估了用于拇外翻的微创Chevron Akin手术的学习曲线。共有120只连续的脚接受了用于有症状拇外翻的微创Chevron Akin手术,其中14只被排除。他们平均随访了25(范围18至38)个月。使用美国矫形足踝协会评分对患者进行临床评估。记录并发症和患者满意度。分析X线片并记录拇外翻和跖间角矫正的测量值。接受手术患者的平均年龄为55(范围25至81)岁。在78例患者中,76例(97.4%)为女性,2例(2.6%)为男性;28例(35.9%)为双侧病例。美国矫形足踝协会的平均评分从术前的56(范围23至76)提高到术后的87(范围50至100)(p <.001)。术前拇外翻和跖间角的平均度数分别为29.7°(范围12°至46°)和14.0°(范围8°至20°)。相应的术后角度分别为10.3°(范围0°至25°)和7.6°(范围3°至15°;p <.001)。87%(106例中的92例)患者对手术结果满意。再次手术的发生率为14%(106例中的15例)。这些是该技术仅有的报告结果。它们显示出陡峭的相关学习曲线。然而,结果是有希望的,并且学习曲线与开放性拇外翻手术相当。