| Objective: A comparative analysis of the clinical efficacy of single-incision proximal and distal Chevron osteotomy combined with distal soft tissue lysis for the treatment of moderate and severe hallux valgus,provides a reference for future clinical treatment of moderate and severe hallux valgus.Methods:The data of 52 patients(64 feet)with moderate and severe hallux valgus admitted to the orthopedic ward of our hospital from 2018 to 2019 were selected,of which27 patients(33 feet)in group A underwent single-incision proximal Chevron osteotomy combined with distal soft tissue lysis;25 cases(31 feet)in group B underwent singleincision distal Chevron osteotomy combined with distal soft tissue lysis;both surgical internal fixators were the same plate and screw.Before and after the operation,the frontal and lateral X-rays of the weight-bearing foot were taken to collect and analyze the hallux valgus angle(HVA),first,Intermetatarsal angle(Intermetatarsal angle,IMA).The selected patients were analyzed using the AOFAS scoring system,and the postoperative satisfaction questionnaire was analyzed.Result:1.There were 50 patients(62 feet)in group A and group B.all of the 50 patients who were followed up successfully healed within 10 weeks,and no obvious complications were found.2.Group A: Patients who underwent single-incision proximal Chevron osteotomy combined with distal soft tissue lysis: HVA recovered from 40.79±12.47° preoperatively to 15.08±8.08° postoperatively,and the follow-up one-year follow-up was 15.68±8.03°;IMA An average of 14.68±3.99° before surgery was restored to 9.27±2.39° after surgery,and the one-year follow-up was 9.69±2.61°,and all angles were significantly recovered compared with before.There were statistically significant differences in the follow-up 3months after operation and one year after operation compared with those before operation(P<0.001).AOFAS score: The average preoperative score was 34.74±13.44 points,which increased to 77.06±13.07 points after surgery.The one-year follow-up after surgery was78.26±13.52 points.There were statistically significant differences between the one-year follow-up after surgery and the one before surgery(P<0.001).Postoperative satisfaction survey: 92.0% of patients rated the comfort level of the affected foot after the operation as "very satisfied" and "satisfied",and rated the aesthetic appearance of the affected foot as "very satisfied" and "satisfied".Accounted for 80%,and 92.0% of the patients evaluated the degree of motion of the hallux after the operation as "very satisfied" or "satisfied".3.Group B: Patients who underwent single-incision distal Chevron osteotomy combined with distal soft tissue lysis: HVA recovered from 39.89±11.29° before surgery to16.08±6.03° after surgery,and the one-year follow-up after surgery was 16.06±5.91°;IMA From preoperative average 16.26±3.67° to 9.47±2.63° postoperatively,the one-year follow-up was 9.32±2.32°,all angles recovered well,and there were statistical differences in the follow-up 3 months after the operation and the one year after the operation compared with that before the operation(P<0.001).AOFAS score: The average preoperative score was 33.48±12.72 points,which increased to 75.13±7.70 points after surgery,and the one-year follow-up after surgery was 76.03±7.96 points.There were statistically significant differences between the postoperative and postoperative one-year follow-up(P<0.001).Postoperative satisfaction survey: 92.0% of patients rated the comfort level of the affected foot as "very satisfied" and "satisfied",and the percentage of patients rated "very satisfied" and "satisfied" as the aesthetics of the postoperative foot.96.0%,and 92.0% rated the motion of the hallux toe as "very satisfied" or "satisfied" after the operation.4.There were no significant differences in HVA and IMA at the same time between group A and group B at 3 months and 1 year after operation(P>0.05).The two groups of patients were compared and analyzed the AOFAS scores at 3 months and 1 year after surgery.It was found that there was no statistical difference at the same time after surgery(P>0.05).Using the chi-square test analysis,it was found that there was no statistical difference in the satisfaction with shoes,appearance and range of activities between the A and B groups after the operation(P>0.05);but in terms of the satisfaction with the appearance,group B(Remote)The number of satisfied people is significantly higher than that of Group A.The reason for the no statistical difference between the two parties is considered to be the small number of patients and the small gap.Conclusion:1.The clinical effect of distal chevron osteotomy combined with distal soft tissue operation is similar to that of proximal chevron osteotomy combined with distal soft tissue operation,which is an effective and reliable method to correct moderate to severe hallux valgus.2.Single incision chevron osteotomy combined with distal soft tissue release in the treatment of moderate and severe hallux valgus has high aesthetic value. |
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