| Background:Hallux valgus is a common condition estimated to affect as many as 23%of adults.With the change of life style,the incidence of bunion is increasing year by year.If the treatment is not timely,the quality of life of patients will be seriously affected.In the face of a large number of patients,how to safely and effectively correct the bunion deformity,and reduce the trauma and complications brought by surgery,is of great research value.Since 1871,when the surgical technique was first described,many surgical treatments for the correction of hallux valgus have been proposed.But none of them addresses all cases.a V-shaped distal osteotomy,traditionally indicated for correction of mild to moderate HV.Many studies have recently demonstrated that chevron osteotomy can allow correction of more severe deformities.For the management of moderate to severe HV deformity,recent studies found no significant clinical and radiographic differences between patients treated with proximal and distal metatarsal osteotomies.This was also the case for the reported complications.Accordingly,we underline that the extension of the indications for distal metatarsal osteotomies may be a viable option.Objective:To explore the effectiveness of clinical of Chevron osteotomy for hallux valgus at severe degree.Methods:The subjects of this study were 17 patients with severe hallux valgus admitted to the Department of Hand and Foot Microsurgery of subei people’s hospital in jiangsu from June 2013 to December 2018.There were 2 males and 15 females,aged 46-76 years(mean 62.4±9.7 years).All patients were treated with a Chevron osteotomy at the distal end of the first metatarsal.Preoperative hallux valgus Angle(HVA)was 40.5°～62.0°(49.16°±6.54°);the 1st and 2nd intermetatarsal Angle(IMA)was 16.2°～24.6°(19.88°±1.94°);preoperative pain index VAS score was 4～8points(6.2±1.2);Preoperative AOFAS scores was 10～67(39.7±16.4);postoperative follow-up was 12～30(22.6±7.8)months.At 1.5 months,3 months and 12 months after the operation,the patient was returned to the clinic and the patient’s recovery status was timely known.The 1st and 2nd intermetatarsal angles(IMA)and hallux valgus angle(HVA)measured from weight-bearing X-ray films were compared between pre-operation and the final follow up.Preoperative and postoperative American orthopaedic foot and ankle association(AOFAS)scores were compared to evaluate clinical outcomes.Results:All 17 cases(23 feet)in this group were followed up for an average of(22.6±7.8)months(range,12-30 months).HVA and IMA obtained after operation were all improved compared with pre-operation(P<0.05).Preoperative HVA 40.5°～62.0°(49.16°±6.54°)decreased to 3.2°～38.6°(21.58°±11.09“)after operation at the last follow-up,and had statistical difference before and after operation(t=15.03,P<0.05).Preoperative IMA16.2°～24.6°(19.88°±1.94°)decreased to 4.2°～15.3°(9.72°±3.37°)after operation at the last follow-up,and had statistical difference before and after operation(t=12.52,P<0.05).VAS score decreased from(6.2±1.2)before operation to(2.0±0.9)after operation at the last follow-up(t=22.57,P<0.05).AOFAS score increased from(39.7±16.4)before operation to(76.4±15.4)after operation at the last follow-up(t=15.83,P<0.05).Conclusions:The distal metatarsal Chevron osteotomy can effectively improve the function and appearance of severe hallux valgus.It can achieve good clinical efficacy through flexible combination of soft tissue surgery,Weil osteotomy or arthroplasty.It is one of the effective clinical treatment methods with high patient satisfaction. |
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