Scarf and Weil osteotomies for correction of rheumatoid forefoot deformities: A review of 20 cases

The forefoot is commonly affected in rheumatoid arthritis. Little has been written of the results of metatarsophalangeal joint preservation in rheumatoid arthritis. We describe the results of the Scarf and Weil osteotomy for correction of forefoot deformities in patients with rheumatoid arthritis. Between 1996 and 1999, 17 patients (20 feet) underwent a Scarf osteotomy for their hallux valgus deformity and in 17 feet a Weil osteotomy of the lesser metatarsophalangeal joints. Radiographic examination was performed preoperatively and at a mean follow up of 65 months. A questionnaire was used at a minimum follow up of 6 years. The hallux valgus angle improved from 41° to 28° at follow up. The majority of the patients (79%) were satisfied with the result during follow-up. We found no wound infections, neuralgia or osteonecrosis of the first metatarsal. In three patients, a fusion of the first MTP joint was performed at follow up.In conclusion, the Scarf and Weil osteotomy is a useful method for MTP joint preserving surgery in rheumatoid forefoot deformities without severe impairment of the MTP joints.     

第1跖列稳定术联合第2-5跖骨头切除术治疗晚期类风湿关节炎前足畸形

目的:介绍第1跖列稳定联合第2-5跖骨头切除术治疗晚期类风湿关节炎(rheumatoid arthritis,RA)前足畸形的手术方式并对中短期临床疗效进行评价。方法:2006年10月至2010年8月收治的晚期RA前足畸形97例患者进行回顾性分析。其中,男9例,女88例;单足65例,双足32例;年龄36～67岁,平均54岁;病程6～32年,平均17年。所有病例存在严重的拇外翻同时合并第1跖跗关节不稳,第2-5跖趾关节脱位及僵硬。采用第1跖列稳定联合第2-5跖趾关节成形术对其进行治疗。通过影像学资料测量拇外翻角(Hallux valgus angle,HVA),跖骨间角(intermetatarsal angle,IMA),并采用JSSF(Japanese Society for Surgery of the Foot)评分对临床疗效进行评估。结果:97例患者中失访5例(7足),平均随访37个月(6～52个月),其中1例术后1年因急性心肌梗死死亡。术前JSSF评分(33.2±8.2)分,末次随访时改善至(67.3±3.1)分(P<0.01);HVA由术前(50.0±11.8)°纠正至术后(21.2±3.2)°(P<0.01);IMA由术前(15.5±3.6)°纠正至术后(9.7±6.6)°(P<0.01)。发生跖趾关节骨不连4足;术后8～11月摄片发现第1楔骨内高密度改变3足;出现拇内侧切口延迟愈合9足;跖趾关节内固定感染2足;跖跗关节内固定感染1足;第2-5跖趾关节术后16足畸形复发。结论:晚期RA患者的前足病变涉及范围广,畸形严重。采用第1跖趾关节融合联合Lapidus术式重建第1跖列的外形及稳定性,跖骨头切除术纠正第2-5跖趾关节畸形的方式重建前足疗效可靠。该术式适用于重度拇外翻合并IMA增大及第1跖跗关节不稳,同时存在第2-5跖趾关节僵硬性半脱位的患者。     

Joint-preserving surgery in rheumatoid forefoot: preliminary study with more-than-two-year follow-up

The authors propose a joint-preserving surgery for rheumatoid forefoot deformities as an alternative to the "classic" surgical approach to the rheumatoid forefoot. The main principle is joint preservation by shortening osteotomies of all the metatarsals performed at the primary location of the rheumatoid forefoot lesions, namely the metatarsophalangeal (MTP) joints and metatarsal heads. A scarf osteotomy is normally performed on the first ray. A Weil osteotomy is performed on the lesser metatarsals. Excellent correction of the hallux valgus deformity in the rheumatoid forefoot can be achieved with a scarf osteotomy in 92% of cases without the need for MTP joint arthrodesis. Similarly, 86% of the lateral metatarsal heads can be preserved using Weil osteotomies.     

旋转Scarf截骨术治疗拇外翻合并第1跖骨旋转

目的：探讨旋转Scarf截骨术治疗拇外翻（hallux valgus,HV）合并第1跖骨旋转的临床疗效。方法：自2018年1月至2019年10月采用旋转Scarf截骨术治疗35例（40足）HV合并第1跖骨旋转畸形患者,其中男5例,女30例;年龄25～76(40.32±5.43)岁。观察并比较手术前后拇外翻角（hallux valgus angle,HVA）,第1、2跖骨间角（intermetatarsal angle,IMA）,第1跖骨远端关节面角（distal metatarsal articular angle,DMAA）,第1跖骨长度（the first metatarsal length,FML）,术后采用美国矫形骨科学会足踝外科学组（American Orthopedic Foot and Ankle Society,AOFAS）拇趾-跖趾-趾间关节评分和疼痛视觉模拟评分（visual analogue scale,VAS）系统进行功能评价。结果 ：35例（40足）均获得随访,时间12～36(14.35±3.62)个月。HVA、IMA和DMAA分别由术前的（36.32±4.5...     

Rheumatoid forefoot reconstruction: Outcome of 1st metatarsophalangeal joint fusion and the Stainsby procedure in the lesser toes

BackgroundRheumatoid arthritis is a chronic inflammatory disease involving connective tissue and joints. The most common rheumatoid forefoot deformities are hallux valgus and clawed lesser toes. There are a number of surgical procedures that have been described offering symptomatic relief and anatomical correction.ObjectivesThis prospective case series aims to assess outcome in patients with rheumatoid forefoot deformities who underwent a novel combination of 1st metatarsophalangeal joint fusions and Stainsby procedures.MethodsThirteen procedures were performed on 12 consecutive patients with an age range of 55–71 (mean = 62) between 02/2009 and 05/2011. AOFAS scoring was performed preoperatively and again six and 12 months post-surgery. Hallux valgus (HVA) and intermetatarsal angles (IMA) were measured preoperatively and six weeks and six months postoperatively.ResultsThe mean AOFAS score increased from 46 to 72, 12 months postoperatively. The mean HVA reduced from 48° preoperatively to 14° six months postoperatively. The IMA decreased from 15° to 10° six months postoperatively.ConclusionsThe novel approach of 1st metatarsophalangeal fusion combined with lesser toe metatarsal head sparing is an effective procedure that reduces forefoot deformity and pain.     

Forefoot reconstruction: Effectiveness of Stainsby operation in treating disclocated lesser toes

BackgroundDeformity of the forefoot is a common disabling problem especially in chronic rheumatoid arthritis. The most common deformities are hallux valgus and dorsally dislocated clawed lesser toes.ObjectiveThis paper assesses results of forefoot reconstruction with emphasis on the effectiveness of Stainsby's procedure in treating severely clawed lesser toes with irreducible dislocation at the metatarsophalangeal joint. The purpose of this procedure is to remove the deforming forces causing depression of the metatarsal head, and restore the dorsally displaced plantar plate of the MTP joint and the related part of the plantar fat pad to their correct position beneath the metatarsal head.MethodSeventy-four patients were operated on between 1998 and 2003. Sixty-nine patients (94 feet) were available for review at an average of 32 months (range 10–67) post surgery. American Orthopaedic Foot and Ankle Scores (AOFAS) were measured and footprints were obtained. Patients were asked about overall satisfaction and whether they would recommend the operation to a family member.ResultsEighty-nine of the 94 feet (95%) had severe or moderate pain preoperatively under the dislocated metatarsal head; only 19 (20%) had significant pain at review. Tender plantar callosities were reduced from 76 feet preoperatively (81%) to 31 feet (33%) at review, these were mainly under un-operated metatarsal heads. Footprints showed a normal loading under 63% of operated metatarsal heads. AOFAS scores were increased from a mean of 19 preoperatively to 52 at review. Residual valgus of the big toe of more than 25° persisted in 33 feet (35%). Corrective osteotomy of 44 first metatarsals resulted in significant residual valgus in 16 feet (36%).ConclusionsStainsby operation was effective in relieving pain and skin callosities from under dislocated lesser metatarsal heads, and in reducing shoe problems, but the osteotomy performed by the authors was unreliable in correcting valgus of the big toe.     

Does preoperative deformity diminish radiographic outcome after hallux valgus correction with scarf osteotomy?: A retrospective study of 102 cases

BackgroundScarf osteotomy is a frequently used technique to correct moderate to severe hallux valgus deformities. Recurrence of a deformity is a commonly reported complication after surgery. The aim of our study was to evaluate the impact of preoperative deformity on radiological outcome in terms of postoperative loss of correction after scarf osteotomy.Methods102 patients, in which a hallux valgus deformity was corrected with an isolated scarf osteotomy were included. Weightbearing radiographs were analyzed preoperatively, postoperatively, after 6 weeks and after three months (mean 10.9 months SD 17.2 months). The following radiological parameters were used for analysis: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), position of the sesamoids, first metatarsal length, and first metatarsophalangeal joint congruity.ResultsSignificant correction of IMA, HVA, DMAA, sesamoid position and joint congruity was achieved (p < 0.001). The IMA improved from 15.8 ± 2.3 to 4.3 ± 2.8°, the HVA from 32.6 ± 6.8 to 9.1 ± 7.2, and the DMAA from 11.4 ± 6.9 to 8.4 ± 5.2°, respectively. In contrast to DMAA, throughout followup we could detect loss of correction for HVA and for IMA amounting 6.3° ± 5.8 and 3.8° ± 2.8 respectively. Loss of HVA correction revealed a significant correlation with preoperative DMAA, but not with the other preoperative radiological parameters.ConclusionsPreoperative deformity does not correlate with postoperative loss of correction after scarf osteotomy, except DMAA.Clinical relevanceOur results may be helpful in counseling patients regarding recurrence of hallux valgus deformity after scarf osteotomy.Level of evidenceTherapeutic, Level IV, retrospective case series.     

Scarf截骨联合软组织平衡松解治疗重度拇外翻

目的：探讨Scarf截骨联合软组织平衡治疗重度拇外翻的手术疗效。方法：回顾性分析2019年6月至2021年6月采用Scarf截骨联合软组织平衡手术治疗的38例（50足）重度拇外翻患者的临床资料,男6例（8足）,女32例（42足）;年龄29～64(54.7±6.8)岁;左侧26足,右侧24足;病程5～23(12.4±3.9)年。比较手术前后拇外翻角（hallux valgus angle,HVA）、第1、2跖骨间角（intermetatarsal angle,IMA）、跖骨远端关节面角（distal metatarsal articular angle,DMAA）,观察术后并发症发生情况。术前和末次随访时采用美国足与踝关节协会（American orthopedic foot ankle society,AOFAS）评分评价前足功能恢复情况,采用视觉模拟评分法（visual analogue scale,VAS）评价患者疼痛缓解程度。结果：38例患者（50足）均获随访,时间15～23(18.3±3.2)个月。HVA、IMA、DMAA术前分别为（44.61±3.92）°、（18.74±2....     

第一跖趾关节融合联合二至五跖趾关节成形治疗类风湿关节炎致前足畸形

 目的 探讨采用第一跖趾关节融合联合二至五跖趾关节成形治疗类风湿关节炎致前足畸形的效果。方法 回顾性分析2007年6月至2010年10月采用第一跖趾关节融合联合二至五跖趾关节成形治疗19例(35足)类风湿关节炎致前足畸形患者资料,男2例(4足),女17例(31足);年龄33～73岁,平均56岁。患者均有不同程度外翻锤状趾畸形和跖痛。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)趾、跖趾、趾间关节评分及视觉模拟(visual analogue scale,VAS)评分评价手术效果。在术前及术后X线片上测量外翻角(hallux valgus angle,HVA)及第一、二跖骨间角(intermetatarsal angle,IMA),了解畸形矫正情况。结果 术后17例(32足)患者获得平均42个月随访,患足外形均得到不同程度改善;29足跖痛完全消失;3足出现第五跖骨外侧转移性跖痛,经垫前足减压垫缓解。1足因趾末节部分坏死而切除。成形的跖趾关节均有不同程度僵硬。AOFAS评分、VAS评分、HVA及IMA度数,术前分别为(46．82±6．13)分、(9.03±1.82)分、38.96°±10.13°、15.87°±3.43°,末次随访时为(84.25±2.87)分、(2.12±0.67)分、15.84°±5.12°、10.35°±1.67°。根据AOFAS评分,优23足,良5足,可4足,优良率为87.5%(28/32)。结论 第一跖趾关节融合联合二至五跖趾关节成形治疗类风湿关节炎致前足畸形效果优良,术后能明显矫正畸形,缓解疼痛,改善功能。     

‘Reverse’ scarf osteotomy for bunionette correction: Initial results of a new surgical technique

BackgroundThe bunionette or tailor's bunion is a lateral prominence of the fifth metatarsal head. It is usually characterised by a wide intermetatarsal angle (IMA) between the 4th and 5th metatarsals, varus of the metatarsophalangeal (MTP) joint, pain and callus formation. Various distal, shaft and basal osteotomies have been described in the literature. We have described a reverse scarf osteotomy for bunionette correction.Patients and methodsWe have used a ‘reverse’ scarf osteotomy in 12 cases (10F: 2M) with a mean follow-up of 12 months (range 5–22 months) with radiographs and clinical scoring.ResultsPost operatively, mean IMA improved from 13.1° to 7.27° (range 2.0–11.5°); mean 5th MTP angle improved from 19.9° to 6.36° (range 2.8–9.0°) and postoperative mean AOFAS improved from 54.25 to 89.58 (range 70–100).Conclusion‘Reverse’ scarf osteotomy in the correction of bunionette deformity offers promising results in the short term.     

改良Chevron 截骨术治疗中重度足拇外翻

目的:探讨第1跖骨远端改良Chevron截骨治疗中重度拇外翻的方法和临床疗效.方法:2015年1月至2019年1月采用改良Chevron截骨结合第1跖趾关节外侧软组织松解手术治疗28例(30足)中重度拇外翻患者,其中男2例(2足),女26例(28足);年龄35 ～74 (57.3±9.3)岁;左侧10足,右侧16足;双...     

Rheumatoid Forefoot Reconstruction in Nonrheumatic Patients: Lesser Metatarsal Head Resection versus Osteotomy

In the literature, first metatarsophalangeal joint arthrodesis with lesser metatarsal head resection seems to be a reliable procedure in rheumatoid foot deformity. Maybe this procedure could be proposed in nonrheumatoid severe forefoot deformity (hallux valgus angle >40° and lesser metatarsophalangeal dislocation). The aim of this study was to compare radiological and clinical outcomes between lesser metatarsal head resection and lesser metatarsal head osteotomy in nonrheumatoid patients. Thirty-nine patients (56 feet) suffering from well-defined nonrheumatoid severe forefoot deformity were retrospectively enrolled in our institution between 2009 and 2015. Metatarsal head resection and metatarsal head osteotomy represented 13 patients (20 feet) and 26 patients (36 feet), respectively. In this observational study, a rheumatoid population (21 patients) was included as the control. The clinical outcome measures consisted of American Orthopaedic Foot and Ankle Society score, Foot and Ankle Ability Measurement, and Short Form-36. The radiological outcomes were: intermetatarsal angle, hallux valgus angle, and metatarsophalangeal alignment. Mean follow-up was 24 months. Satisfaction rate was, respectively, 92% for resection, 91% for osteotomy procedure, and 80% for surgery in rheumatoid patients. Short Form-36 global score was, respectively, 80.7 (52.5-96.4), 76 (57.7-93), and 68.3 (22.6-86). No functional outcome difference was found between resection and osteotomy procedures, except that the metatarsal head resection group had poorer results in sports activities than the osteotomy group. Complications were similar between osteotomy and resection (p > .05). The radiological outcomes were improved significantly from preoperative to postoperative. First metatarsophalangeal joint arthrodesis with lesser metatarsal head resection in nonrheumatoid severe forefoot deformity might be a good therapeutic option.     

两种截骨术式治疗中重度拇外翻影像学效果与临床疗效的系统评价

目的：系统评价Chevron截骨术与Scarf截骨术治疗中重度拇外翻的影像学效果和临床疗效。方法：计算机检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、万方期刊全文数据库（Wanfang Data）关于Chevron截骨术与Scarf截骨术治疗拇外翻的随机对照研究（RCT）,检索时限从建库至2018年6月。由2名研究者独立按照纳入和排除标准筛选文献,评价纳入文献的偏倚风险和提取相关观察指标后,采用RevMan 5.3.5软件进行Meta分析。比较两种截骨术式术后拇外翻角（HVA）、1-2跖骨间角（IMA）、跖骨远端关节面固有角（DMAA）、美国骨科足踝外科协会评分（AOFAS）、术后切口并发症以及患者满意度。结果：最终纳入6篇随机对照研究文献,共507例（足）患者,92.5%的患者为中重度拇外翻,其中Chevron截骨术261例（足）,Scarf截骨术246例（足）。Meta分析结果显示：Chevron截骨术在矫正HVA方面优于Scarf截骨术[MD=-1.95,95% CI （-2.64,-1.27）,P<0.000 01]。而两种方法在IMA[MD=-0.42,95% CI （-1.04,0.21）,P=0.19],DMAA[MD=0.78,95% CI （-0.72,2.29）,P=0.31],AOFAS评分[MD=2.47,95% CI （-2.38,7.33）,P=0.32],术后切口并发症[RR=1.09,95% CI （0.54,2.20）,P=0.82],患者满意度[RR=1.00,95% CI （0.96,1.05）,P=0.92]方面比较差异无统计学意义。结论：Chevron截骨术操作简单、跖骨短缩少、创伤小,在治疗中重度拇外翻矫正HVA方面优于Scarf截骨术,在IMA、DMAA、AOFAS评分、并发症、患者满意度方面二者效果相似。     

单纯截骨术矫正第1、2跖骨间角增大型拇外翻的疗效观察

目的:观察单纯运用截骨矫形术治疗拇外翻的疗效,初步探讨其适用范围和条件。方法:自2009年12月至2011年4月,采用单纯截骨术治疗第1、2跖骨间角增大型拇外翻20例(32足),男1例(1足),女19例(31足);年龄22～64岁,平均40岁;病程2～31年,平均12年。轻度6足,中度20足,重度6足;术前患者均有第1跖趾关节疼痛且外侧软组织紧张度检查正常;手术前后对足的应力正位X线的拇外翻角(hallux valgus angle,HVA)、第1、2跖骨间角(intermetatarsal angle,IMA)、胫侧籽骨位置进行比较;采用拇外翻疗效评定标准从畸形矫正、拇趾跖趾关节活动度,患者满意度等方面对疗效进行评定。结果:20例均获随访,时间6～18个月,平均8.5个月;术后切口愈合良好,无感染及跖骨头坏死等并发症,95.1%的患者对疗效感觉非常满意或满意。AOFAS评分由术前(53.1±7.5)分提高到最终随访的(93.1±1.9)分(P<0.05);HVA由术前(33.4±7.8)°纠正到(11.9±3.6)°(P<0.05);IMA由术前(12.3±3.0)°提高到(6.3±1.9)°(P<0.05);胫侧籽骨位置由1.9改善致0.9(P<0.05)。结论:.外侧软组织紧张度正常的拇外翻患者其病理变化主要为跖骨内收,仅利用单纯截骨术治疗即可获得满意疗效,无须切断拇收肌。     

Scarf截骨治疗中重度[足母]外翻的短期疗效分析

背景：野外翻是最常见的前足畸形,越来越受到矫形外科医生的重视,其治疗方式多种多样,如何选择适合的手术方式是治疗成功的关键。目的：探讨Scarf截骨术治疗[足母]外翻的疗效。方法：2010年7月至2012年6月,我院采用Scarf截骨术治疗中重度跽外翻患者47例（61足）,男5例（7足）,女42例（54足）;年龄20-78岁,平均52．2岁。比较手术前后[足母]外翻角及第1、2跖骨间角纠正程度。采用AOFAS评分评估患者临床症状改善情况。结果：所有患者均获得随访,随访时间4-8个月,平均6个月。[足母]外翻角由术前42．6。减小至12．9°,平均减小29．7°。第1、2跖骨间角由术前18．4°减小至8．9°,平均减小9．5°。AOFAS评分由术前49．9分增加至术后86．2分,平均增加26．5分。并发症发生率10％。结论：Scarf截骨术治疗中重度躅外翻可以获得较好的短期临床结果,但需严格掌握手术适应证。     

The Rotational Effect of Scarf Osteotomy With Transarticular Lateral Release on Hallux Valgus Correction

The purpose of this study was to explore the rotational effect of scarf osteotomy with transarticular lateral release (TALR) on hallux valgus correction. From January 2016 to January 2018, 28 consecutive patients (30 feet) were included in this study. The first intermetatarsal angle (IMA), hallux valgus angle (HVA), and round-shaped lateral edge of the first metatarsal head (R sign), and sesamoid rotation angle (SRA) were recorded prior to and 3 months after the surgery. The rotation of the capital fragment of the first metatarsal was termed the capital rotation angle (CRA) and was measured intraoperatively after the completion of scarf osteotomy. The IMA, HVA, and SRA were significantly reduced from 13.9 ± 4.9°, 34.6 ± 7.4°, and 28.7 ± 9.8° to 2.4 ± 2.3°, 7.3 ± 4.7°, and 13.4 ± 8.8°, respectively (p < .01 for all). The mean CRA was 7.0 ± 3.4° and was not significantly correlated with the reduction of IMA and SRA (p > .05 for all); nor was it significantly correlated with IMA preoperatively and postoperatively (p > .05 for all) or the reduction of SRA and IMA (p > .05). The R sign was positive in 40% (12/30) of the feet preoperatively compared to 13.3% (4/30) postoperatively (p < .001). Scarf osteotomy produced a supination effect on the capital fragment of the first metatarsal and supinated the sesamoids via lateral translation of the first metatarsal head. These changes may contribute to the correction of the pronation component of hallux valgus deformity.     

第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻

目的：探讨第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻临床疗效。方法：回顾性分析自2017年3月至2021年8月接受第1跖趾关节融合结合旋转Weil截骨治疗的重度跖内收型拇外翻患者37例（69足）,男8例（11足）,女29例（58足）;年龄67～83(70.03±2.87)岁;左侧3例,右侧2例,双侧32例。分别于术前、术后6周及末次随访时,采用疼痛视觉模拟评分（visual analogue scale,VAS）进行疼痛缓解程度评价。术前及末次随访时采用美国骨科足踝外科学会（American Orthopaedic Foot and Ankle Surgery,AOFAS）前足评分对患足功能进行评价。并测量手术前及末次随访时拇外翻角（hallux valgus angle,HVA）,第1、2跖间角（intermetatarsal angle,IMA）的变化情况。结果：37例（69足）患者获得随访,时间12～48 (22.8±0.6)个月。术后7～10(8.00±1.21)周第1跖趾关节处达到骨愈合,无延迟愈合及不愈合发生。术前HVA (44.30±2.84)°与...     

Scarf and Weil Metatarsal Osteotomies of the Lateral Rays for Correction of Rheumatoid Forefoot Deformities: A Systematic Review

Scarf osteotomy of the first ray combined with Weil distal oblique shortening osteotomies of the lateral rays has recently been proposed for the treatment of global rheumatoid forefoot deformities because of the perceived benefit of sparing the metatarsal-phalangeal joints. Furthermore, it has been proposed that undergoing this form of global forefoot reconstruction is reliable based on specific preoperative and intraoperative techniques used to realign the individual rays. Finally, it has been proposed that performing global forefoot reconstruction in the rheumatoid patient population can be safely performed and does not prevent the ability to perform revision surgery. The author undertook a systematic review of electronic databases and other relevant sources to identify material relating to Scarf osteotomy of the first ray combined with Weil distal oblique shortening osteotomies of the lateral rays for the treatment of global rheumatoid forefoot deformities. Information from peer-reviewed journals, as well as from non–peer-reviewed publications, abstracts and posters, textbooks, and unpublished works, was also considered. In an effort to procure the highest quality studies available, studies were eligible for inclusion only if they involved patients undergoing Scarf osteotomy of the first ray combined with Weil distal oblique shortening osteotomies of the lateral rays, evaluated patients at mean follow-up of 12-months or longer duration, commented on the reliability of metatarsal realignment, and included details of complications, as well as the incidence and severity of wound-healing complications. Two studies were identified that met the inclusion criteria involving only 8 patients (8 feet) with 1 patient undergoing surgical revision in the form of arthrodesis secondary to development of a septic first metatarsal–phalangeal joint. Partial incision dehiscence developed in 2 patients, 1 healed with local wound care and the other led to the septic first metatarsal–phalangeal joint mentioned previously. Finally, stress fracture of the third metatarsal and fourth metatarsals developed that healed without problems in one other patient. Rather than providing strong evidence for or against the use of Scarf osteotomy of the first ray combined with Weil distal oblique shortening osteotomies of the lateral rays for the treatment of global rheumatoid forefoot deformities, the results of this systematic review make clear the need for methodologically sound prospective cohort studies and randomized controlled trials that focus on the use of this form of surgical intervention.     

Scarf与第1跖骨双平面截骨治疗拇外翻畸形的病例对照研究

目的：比较Scarf截骨术与第1跖骨双平面截骨术（double metatarsal osteotomy,DMO）治疗中重度拇外翻的临床疗效。方法：回顾性分析2017年1月至2019年12月治疗的50例（81足）中重度拇外翻畸形患者,根据截骨方式不同分为Scarf截骨术（Scarf osteotomy,SO）组或DMO组。SO组26例（44足）,男1例,女25例;年龄48~65（55.50±4.67）岁;中度18例（30足）,重度8例（14足）。DMO组24例（37足）,男1例,女23例;年龄45~62（52.10±6.80）岁;中度14例（24足）,重度10例（13足）。手术前后在足部负重正位X线片上测量并比较拇外翻角（hallux valgus angle,HVA）、第1、2跖骨间角（intermetatarsal angle,IMA）及远端跖骨关节面角（distal metatarsal articular angle,DMAA）,第1跖骨相对长度（relative length of first metatarsal,RLFM）的变化情况。术前及末次随访时采用美国足踝外科协会（American Orthopaedic Foot and Ankle Society,AOFAS）拇趾、跖趾、趾间关节评分进行临床疗效评价。观察两组患者负重时间及并发症情况。结果：50例患者均获得随访,SO组随访时间12~36（20.50±6.22）个月,DMO组16~28（19.80±2.44）个月,两组随访时间比较,差异无统计学意义（P>0.05）。所有切口Ⅰ期愈合,术后（20.31±3.17）个月截骨均愈合,SO组术后1例出现获得性拇内收畸形,未出现转移跖痛;DMO组术后2例发生转移性跖痛。两组手术前后HVA、IMA、DMAA、AOFAS评分比较,差异无统计学意义（P>0.05）;术前两组RLFM比较,差异无统计学意义（P>0.05）,两组末次随访时RLFM比较,差异有统计学意义（P<0.05）。SO组部分负重时间及完全负重时间显著早于DMO组（P<0.05）。结论：Scarf截骨与第1跖骨双平面截骨均可有效治疗中重度拇外翻畸形,影像学及临床评估相似,但术后第1跖骨相对长度SO组较DMO组延长,Scarf截骨下地负重时间早于第1跖骨双平面截骨。