评价应用Chevron微创截骨术联合ISO髓内钢板内固定并结合中医正骨手法治疗中度拇外翻的临床疗效。 【方法】采用回顾性研究方法，对49例（62足）中度拇外翻患者行Chevron微创截骨术联合ISO髓内钢板内固定，结合术前、 术中及术后中医正骨手法治疗，术后采用视觉模拟量表（VAS）评分、美国足踝外科协会（AOFAS）前足评分进行疗效评价，记 录患者术前及术后12个月足负重位X线片的拇外翻角（HVA），第一、二跖骨间夹角（IMA），第一跖骨远端关节面夹角 （DMAA）的变化情况。【结果】（1）本组49例患者均获得随访，随访时间12～24个月，平均（20.6 ± 3.1）个月。（2）影像学评 估情况：术后12个月，49例（62足）患者的平均HVA、IMA、DMAA值均较术前明显降低，差异均有统计学意义（P＜0.01）。 （3）疼痛程度评估情况：术后12个月，49例患者的疼痛VAS评分为（3.14 ± 1.21）分，较术前的（7.26 ± 2.52）分明显降低，差 异有统计学意义（P＜0.01）。（4）关节功能评估情况：术后12个月，49例患者的各项AOFAS前足评分（包括疼痛、功能、拇趾 对线）及总分均较术前明显提高，差异均有统计学意义（P＜0.01）。（5）疗效情况：49例患者的62足中，优53足，良7足，可 2足，优良率达96.77%（60/62）。【结论】Chevron微创截骨术联合ISO髓内钢板内固定并结合中医正骨手法治疗中度拇外翻， 可促进拇跖趾关节复位，恢复关节平衡，并通过术后康复指导保持关节的平衡状态，临床疗效确切，可有效降低复发率， 最终达到患者术后早期康复的目的。

To evaluate the clinical efficacy of Chevron minimally- invasive osteotomy and internal fixation with ISO intramedullary plate plus traditional Chinese medicine（TCM）bone-setting manipulations for the treatment of moderate hallux valgus. Methods A retrospective study was conducted. A total of 49 patients（62 feet） with moderate hallux valgus were treated with Chevron minimally-invasive osteotomy and internal fixation with ISO intramedullary plate， and were given TCM bone- setting manipulations before the operation， during the operation，and after the operation. The efficacy was evaluated by using the Visual Analogue Scale（VAS）score and the American Orthopedic Foot and Ankle Society（AOFAS） forefoot score after the operation. Before the operation and 12 months after the operation， the hallux valgus angle（HVA）， intermetatarsal angle（IMA） between the first and second metatarsal bone，and the distal metatarsal articular angle（DMAA）showed by X-ray imaging in the weight-bearing position of the foot were recorded. Results（1）All of the 49 patients were followed up for 12 to 24 months，with a mean of（20.6 ± 3.1）months.（2）The X-ray imaging assessment showed that 12 months after the operation，the mean HVA，IMA and DMAA values of the 49 patients（62 feet）were significantly lower than those before the operation，and the differences were all statistically significant（P＜0.01）.（3）Twelve months after the operation，the pain VAS score of 49 patients was（3.14 ± 1.21）points，which was significantly lower than the preoperative score points（7.26 ± 2.52），and the difference was statistically significant（P＜0.01）.（4）The assessment of joint function showed that 12 months after the operation， the scores of various AOFAS items of pain，function and hallux alignment as well as the overall AOFAS scores of 49 patients were significantly higher than those before the operation，and the differences were statistically significant（P＜0.01）.（5）For the 62 feet in 49 patients，the excellent efficacy was achieved in 53 feet，good efficacy was achieved in 7 feet，and fair efficacy was achieved in 2 feet，with the fine rate of 96.77%（60/62）. Conclusion For the treatment of moderate hallux valgus， the application of Chevron minimally-invasive osteotomy and internal fixation with ISO intramedullary plate plus TCM bone-setting manipulations is effective on promoting the reset of hallux-metatarsophalangeal joint， restoring the balance of the joint， and maintaining the equilibrium state of the joint through postoperative rehabilitation guidance. The combined therapy exerts certain efficacy，reduces the recurrence rate，and eventually achieves the early rehabilitation after the operation.

R274.9

广东省医学科研基金立项项目（编号：A2023480）；东莞市社会发展科技项目（编号：20231800900211）；广东省中医药局科研项目 （编号：20221419）