[Effectiveness of double metatarsal osteotomy for severe hallux valgus with increased distal metatarsal articular angle].

To summarize the technique and effectiveness of double metatarsal osteotomy for treating severe hallux valgus with increased distal metatarsal articular angle (DMAA). Between June 2014 and December 2017, 64 patients (94 feet) of severe hallux valgus with an increased DMAA were treated with the double metatarsal osteotomy (distal metatarsal Reverdin osteotomy+proximal metatarsal open wedge osteotomy) combined with Akin osteotomy and soft tissue surgery to correct the deformity. There were 10 males (15 feet) and 54 females (79 feet) with an average age of 44.5 years (range, 26-66 years), including 34 of unilateral foot and 30 of bilateral feet. The Maryland metatarsophalangeal joint score of the American Orthopaedic Foot and Ankle Society (AOFAS) was 54.3±7.4 and the visual analogue scale (VAS) score was 6.0±2.0. The pre- and post-operative AOFAS score, VAS score, DMAA, hallux valgus angle (HVA), first-second intermetatarsal angle (1-2IMA), and the first metatarsal length (FML) were recorded and compared. All incisions healed by first intention. All patients were followed up 12-15 months, with an average of 13.2 months. The complications occurred in 4 feet, including 1 foot of hallux stiffness, 1 foot of numbness at the edge of the wound, 1 foot of metastatic metatarsalgia, and 1 foot of metatarsal bone necrosis. At 1 year after operation, the Maryland metatarsal joint score of AOFAS was 89.2±7.4, showing significant difference compared with preoperative score ( For the patients with severe hallux valgus with increased DMAA, the double metatarsal osteotomy can significantly relieve the clinical symptoms and improve the imaging parameters with less postoperative complications. 总结双平面截骨术治疗合并跖骨远端关节面角（distal metatarsal articular angle，DMAA）增大的重度踇外翻疗效。. 回顾性分析 2014 年 6 月—2017 年 12 月收治并获完整随访的 64 例（94 足）合并 DMAA 增大的重度踇外翻患者临床资料。患者均接受双平面截骨术（跖骨远端 Reverdin 截骨术+跖骨近端开放楔形截骨术）联合 Akin 截骨术及软组织手术。男 10 例（15 足），女 54 例（79 足）；年龄 26～66 岁，平均 44.5 岁。单侧 34 例，双侧 30 例。参照美国矫形足踝协会（AOFAS）Maryland 跖趾关节评分系统评分为（54.3±7.4）分，疼痛视觉模拟评分（VAS）为（6.0±2.0）分。比较手术前后 AOFAS Maryland 跖趾关节评分系统评分及 VAS 评分，以及踇外翻角（hallux valgus angle，HVA）、第 1-2 跖骨间角（first-second intermetatarsal angle，1-2IMA）、DMAA、第 1 跖骨长度（first metatarsal length，FML）。. 术后切口均 Ⅰ 期愈合。患者均获随访，随访时间 12～15 个月，平均 13.2 个月。4 足发生并发症，其中踇僵硬、内侧切口边缘皮肤感觉麻木、转移性跖痛、第 1 跖骨头坏死各 1 足。术后 1 年 AOFAS Maryland 跖趾关节评分为（89.2±7.4）分，与术前比较差异有统计学意义（ 双平面截骨术可以显著改善合并 DMAA 增大的重度踇外翻患者临床症状以及影像学参数，术后并发症少。.