Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China.
Orthop Surg. 2022 Jul;14(7):1369-1377. doi: 10.1111/os.13242. Epub 2022 May 28.
To explore whether modified Chevron osteotomy together with distal soft tissue release would correct moderate to severe HV deformity and what is the minimal clinical important difference (MCID) for objective and subjective evaluating parameters.
From March 2018 to January 2019, 40 hallux valgus patients (including moderate to severe) were enrolled in this retrospective study. The cohort included four males and 36 females. The average age at surgery was 50.95 (range 22-75) years. All patients underwent modified Chevron osteotomy together with distal soft tissue release and completed at least one follow-up at clinic. The American Orthopaedic Foot and Ankle forefoot score (AOFAS, forefoot), Visual Analog Scale (VAS), and Foot Function Index (FFI) were all collected before and after surgery. Besides, the hallux valgus angle (HVA), 1st-2nd intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were measured both before surgery and at last follow-up. All MCID values were calculated by employing distribution-based method.
Thirty-seven patients (92.5%) showed satisfied result at a mean 14.3-month follow-up (range 13-22 month). Two patients complained about residual pain at the bunion, and overcorrection (hallux varus) occurred in one patient. Meanwhile, no patient observed nonunion. Being female, age more than 60, residual HVA deformity (>15°), and post IMA more than 9° showed no statistical relationship with the post-operation residual pain (P > 0.05). However, high VAS score before surgery (more than 7) showed strong correlation with residual pain (P < 0.01). The subjective MCID value was 9.50 for AOFAS, 18.92 for FFI, and 1.27 for VAS, respectively.
The modified Chevron osteotomy together with distal soft tissue release could achieve a satisfied result for moderate to severe HV deformity at early follow-up. The residual pain was associated with severe pain before surgery (VAS more than 7).
探讨改良 Chevron 截骨术联合远端软组织松解术是否能矫正中重度 HV 畸形，以及客观和主观评估参数的最小临床重要差异（MCID）是多少。
本回顾性研究纳入 2018 年 3 月至 2019 年 1 月的 40 例（包括中重度）踇外翻患者，其中男 4 例，女 36 例。手术时的平均年龄为 50.95 岁（范围 22-75 岁）。所有患者均行改良 Chevron 截骨术联合远端软组织松解术，至少在诊所随访一次。术前及术后均采集美国矫形足踝协会前足评分（AOFAS，前足）、视觉模拟评分（VAS）和足部功能指数（FFI）。此外，术前及末次随访时均测量拇外翻角（HVA）、第 1-2 跖骨间角（IMA）和远侧跖骨关节角（DMAA）。所有 MCID 值均采用基于分布的方法计算。
37 例（92.5%）患者在平均 14.3 个月（范围 13-22 个月）的随访中获得满意结果。2 例患者诉前足痛残留，1 例患者出现过度矫正（踇内翻）。同时，无患者发生骨不连。女性、年龄大于 60 岁、残余 HVA 畸形（>15°）和术后 IMA 大于 9°与术后残留疼痛无统计学关系（P > 0.05）。然而，术前 VAS 评分较高（>7）与残留疼痛有很强的相关性（P < 0.01）。AOFAS 的主观 MCID 值为 9.50，FFI 为 18.92，VAS 为 1.27。
改良 Chevron 截骨术联合远端软组织松解术可在早期随访中获得中重度 HV 畸形的满意结果。残留疼痛与术前剧烈疼痛（VAS 评分>7）有关。
