Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China.
Department of pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, P.R. China.
Sci Rep. 2019 Nov 22;9(1):17364. doi: 10.1038/s41598-019-53479-6.
Hallux valgus (HV) is a foot deformity that can be treated with Chevron osteotomy, and a modified plantarward oblique osteotomy has been proposed in recent years. However, no research has focused on the correctional power of the osteotomy. The aim of this study was to examine the character of this plantarward oblique Chevron osteotomy (POCO) and to determine the rationale of this method.Radiographs and clinical data from 65 HV patients (77 feet) with painful callosities were evaluated. The intermetatarsal angle, hallux valgus angle, and relative height of the second metatarsal were measured, and a valid width of the first metatarsal was proposed. A visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society hallux-metatarsophalangeal interphalangeal scale (AOFAS) were used to evaluate the patients' clinical results.There were significant differences in the HVA and IMA. The decline in the height of the second metatarsal was positively related to the decline in the height of the first metatarsal, but the changes were smaller for the first metatarsal. Painful callosities disappeared in 77 feet, 4 (5.1%) patients had no pain but a remaining plantar callosity, and 2 (2.6%) patient had relieved pain with a plantar callosity after follow-up. The VAS scores improved from 8.58 ± 0.50 to 1.96 ± 0.75 points after the operation (p < 0.001). Significant differences were demonstrated in the AOFAS scores (65.81 ± 4.05 vs 87.88 ± 3.41, p < 0.001). The modified POCO prevents the dorsal migration of the metatarsal head, preserves other lesser metatarsals and provides an opportunity for patients who may possibly need additional future deformity correction. Therefore, POCO is a safe and effective method to treat hallux valgus and offers the superior potential benefits of correction and transfer metatarsalgia.
拇外翻（HV）是一种足部畸形，可以通过 Chevron 截骨术治疗，近年来提出了一种改良的跖骨斜行截骨术。然而，目前还没有研究关注截骨术的矫正力。本研究旨在探讨这种跖骨斜 Chevron 截骨术（POCO）的特点，并确定该方法的原理。
评估了 65 例（77 只脚）有疼痛胼胝的 HV 患者的 X 线片和临床资料。测量了跖骨间角、拇外翻角和第二跖骨相对高度，并提出了第一跖骨的有效宽度。使用视觉模拟评分（VAS）和美国矫形足踝协会拇趾-跖趾-趾间关节量表（AOFAS）评估患者的临床结果。
HVA 和 IMA 有显著差异。第二跖骨高度的下降与第一跖骨高度的下降呈正相关，但第一跖骨的变化较小。77 只脚的疼痛胼胝消失，4 例（5.1%）患者无疼痛，但仍有足底胼胝，2 例（2.6%）患者随访时有足底胼胝疼痛缓解。术后 VAS 评分从 8.58±0.50 改善至 1.96±0.75 分（p<0.001）。AOFAS 评分有显著差异（65.81±4.05 比 87.88±3.41，p<0.001）。改良的 POCO 可防止跖骨头背侧迁移，保留其他较小的跖骨，并为可能需要进一步畸形矫正的患者提供机会。因此，POCO 是治疗拇外翻的一种安全有效的方法，具有矫正和转移跖痛症的优势。
