de Las Heras-Romero J, Lledó-Alvarez A M, Andrés-Grau J, Picazo-Marín F, Moreno-Sánchez J F, Hernández-Torralba M
Department of Orthopaedics and Traumatology, Reina Sofía Hospital, Avda. Intendente Jorge Palacios 1, Murcia, 30003, Spain.
Regional Statistical Center, Avda. Teniente Flomesta, s/n, 3ª planta, Edif. Anexo, Murcia, 30001, Spain.
Foot (Edinb). 2019 Sep;40:27-33. doi: 10.1016/j.foot.2019.04.001. Epub 2019 Apr 4.
Surgical treatment of moderate hallux valgus (HV) onwards by Chevron osteotomy and all variants described to date including the recent extended distal Chevron osteotomy (EDCO), yields improvable outcome but with recurrence rate. A new modification of this technique is needed to achieve better results.
34 consecutive female patients suffering from moderate HV underwent a new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR). Outcome was assessed using pre-post operative VAS-Pain, AOFAS Hallux Score and radiological measurements. Mean age was 53.7 years, follow-up 2.7 years and satisfaction score 8.
VAS improved from 7 to 1 (p < 0.001) and AOFAS score from 64 to 90.7 (p < 0.001). Comparing postoperative HV and intermetatarsal (IM) angles of previous studies (either employing a Chevron osteotomy alone or a double Chevron-Akin) with our results, an improvement from 15.6/14.8 to 9.1 and 8.2 /8.8 to 5.6 respectively (p < 0.05) was achieved. Complication and recurrence rates were both 5.8%, lower than the documented rates of other techniques.
The modified technique in the present study was found to be a more effective and reliable method of correcting hallux valgus when compared to other previous procedures. It provides a higher level of satisfaction and excellent outcomes with low complication and recurrence rates. Furthermore, the percutaneous lateral incision improved the cosmetic results by avoiding formation of a dorsal first web space scar. Medial incision is also shorter than the one used for EDCO.
Level IV, case series.
对于中度拇外翻（HV）起，采用 Chevron 截骨术及其迄今描述的所有变体，包括最近的延长远端 Chevron 截骨术（EDCO）进行手术治疗，虽能改善疗效，但存在复发率。需要对该技术进行新的改良以取得更好的效果。
34 例连续的中度 HV 女性患者接受了新的微创延长远端 Chevron 截骨术（MEDCO）及经皮软组织松解术（PSTR）。采用术前术后视觉模拟评分法（VAS）疼痛评分、美国足踝外科协会（AOFAS）拇趾评分和影像学测量来评估疗效。平均年龄为 53.7 岁，随访 2.7 年，满意度评分为 8 分。
VAS 评分从 7 分改善至 1 分（p < 0.001），AOFAS 评分从 64 分提高至 90.7 分（p < 0.001）。将本研究术后的 HV 角和跖间（IM）角与既往研究（单独采用 Chevron 截骨术或双 Chevron - Akin 截骨术）的结果进行比较，分别从 15.6/14.8 改善至 9.1 以及从 8.2 /8.8 改善至 5.6（p < 0.05）。并发症发生率和复发率均为 5.8%，低于其他技术所记录的发生率。
与既往其他手术方法相比，本研究中的改良技术被发现是一种更有效且可靠的矫正拇外翻的方法。它提供了更高的满意度和优异的疗效，并发症和复发率低。此外，经皮外侧切口避免了第一跖背间隙瘢痕的形成，改善了美观效果。内侧切口也比 EDCO 所使用的切口短。
IV 级，病例系列。
