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背景:随着我国老年人口的不断增长,老年性外翻越来越多见.老年性外翻一般畸形严重,很难依靠单一截骨术矫正足部的全部畸形.目的:观察第1跖骨远端Chevron截骨术结合趾骨Akin截骨术治疗老年性外翻的临床疗效.方法:2012年8月至2015年10月采用第1跖骨远端Chevron截骨术结合趾骨Akin截骨术治疗老年性外翻患者138例(253足),男31例(45足),女107例(208足);年龄65~92岁,平均(77.8±2.3)岁.分别于术前1 d、术后7 d、术后6周、末次随访时采用视觉模拟评分法(VAS)、AOFAS的Maryland第1跖趾关节百分评分法进行疼痛评分和功能评定.术前、术后6周、末次随访时拍摄足负重位X线片,测量和记录HVA角、IMA角、DMAA角变化情况,并进行影像学评定.结果:138例全部获得随访,随访时间2~5年,平均(3.6±0.5)年.无一例出现截骨处迟延愈合和不愈合,无跖骨头坏死.所有患者术后7 d、术后6周、末次随访时足部疼痛明显改善,与术前比较差异有统计学意义(P<0.05),以末次随访时更显著(P<0.01).AOFAS的Maryland第1跖趾关节百分评分法功能评定,总优良率为96.8%.HVA角、IMA角、DMAA角均较术前改善明显(P<0.05).末次随访时发现各角度均较术后6周有一定程度的丢失,但无统计学差异,患者亦无临床症状.结论:运用第1跖骨远端Chevron截骨术结合趾骨Akin截骨术治疗老年性外翻的临床疗效明显.手术在单一切口下即可完成,操作相对简单,适宜推广应用.“,”Background:More and more elderly patients suffered from hallux valgus with the aging of population in China. It is very difficult to correct the deformity with single osteotomy due to the severe deformity in elderly patients.Objective:To evaluate the effect of distal Chevron osteotomy combined with Akin osteotomy on hallux valgus in elderly patients. Methods:A total of 138 elderly patients(253 feet)with hallux valgus treated by metatarsal and phalangeal bi-osteotomy be-tween August 2012 and October 2015 were retrospectively analyzed.There were 31 males(45 feet)and 107 females(208 feet)with a mean age of(77.8±2.3)years(range,65-92 years).The pain and function were evaluated by visual analogue scoring(VAS)and AOFAS on the day before surgery,7 days and 6 weeks after surgery.X-ray films of weight-bearing foot were taken to measure HVA,IMA and DMAA before surgery,6 weeks after surgery,and at the final follow-up.Results:The mean follow-up duration was(3.6±0.5)years(range,2-5 years)in all the patients.No delayed healing,nonunion,or necro-sis of head of metatarsal bone were found.Pain was remarkably relieved during follow-up period,which were significantly different from preoperative foot pain (P<0.05), especially at the final follow-up (P<0.01). The overall effective rate was 96.8% according to AOFAS function evaluation. HVA, IMA and DMAA were all significantly improved after surgery. There was a certain degree of loss in each angle at the final follow-up,but no statistical difference was found between them and those angles at 6 weeks after surgery.And no clinical symptoms were complained.Conclusions:Distal Chevron osteoto-my combined with Akin osteotomy is effective for elderly hallux valgus.The operation is relatively simple and can be fin-ished through a single incision.