Sex-Related Differences in Outcomes after Hallux Valgus Surgery

PurposeWith differences between the sexes in foot bone anatomy and ligamentous laxity, there is the possibility that the results of hallux valgus surgery may also differ between the sexes. We aimed to compare the results of hallux valgus surgery between the sexes.ResultsThere were no statistically significant differences in demographics between the sexes. The mean American Orthopedic Foot and Ankle Society score, visual analogue scale for pain, and patient satisfaction at the last follow-up did not differ significantly between the sexes. The mean preoperative hallux valgus angle (HVA) and inter-metatarsal angle (IMA) were not significantly different between the sexes. At the last follow-up, the mean HVA was significantly greater in females (p=0.003) than in males; mean IMA was not significantly different between the sexes. The mean correction of HVA in males was significantly greater than that in females (p=0.014).ConclusionThere were no significant differences between the sexes regarding clinical outcomes after distal and proximal chevron osteotomy. However, male patients achieved greater correction of HVA than female patients. There is a possibility that sexual dimorphism of the foot may affect postoperative HVA.     

First Metatarsal Proximal Opening Wedge Osteotomy for Correction of Hallux Valgus Deformity: Comparison of Straight versus Oblique Osteotomy

Purpose

The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy.

Materials and Methods

We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation.

Results

Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 groups (6.1±2.7° in group A and 6.0±2.1° in group B). However, a greater correction in the HVA and distance from the first to the second metatarsal were found in group B (HVA, 13.2±8.2°; distance, 25.1±0.2 mm) compared to group A (HVA, 20.9±7.7°; distance, 28.1±0.3 mm; p<0.001). AOFAS scores were improved in both groups. However, group B demonstrated a greater improvement relative to group A (p=0.005).

Conclusion

Compared with a straight first metatarsal osteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes.     

基于足负重位CT影像应用Mimics软件测量拇外翻相关指标

目的 探讨基于足负重位CT图像应用Mimics软件测量拇外翻相关角度的准确性及可靠性。方法 前瞻性选择昆明医科大学第一附属医院2016年7月—2017年3月收治的30例(36足)拇外翻患者,应用Mimics软件对患者足负重位CT图像行拇外翻3D重建。应用Mimics软件拟合区域功能自动分析计算生成近节趾骨轴线和第一、二跖骨轴线,并重建第一跖骨远端实际关节面,通过近节趾骨与第一跖骨3D模型进行修正;采用以上解剖学参数实现对拇外翻角(HVA)、跖骨间角(IMA)、跖骨远端关节面夹角(DMAA)的精确测量。由4名测量者分别使用上述计算机辅助CT建模测量法与常规X线测量法对30例拇外翻患者进行测量,比较各组观察指标测量结果的统计学差异,并行Bland-Altman分析一致性。结果 4名测量者采用常规X线法和CT建模重建法测量结果的ICC值分别为0.89和0.91,可靠性优。传统X线测量法测量患者HVA、IMA分别为29.10°±10.04°、13.98°±4.38°,CT建模法测量患者HVA、IMA分别为30.02°±10.62°、13.83°±4.29°,差异均无统计学意义(P值均＞0.05);传统X线测量法测量患者DMAA为12.57°±3.96°,CT建模法测量患者DMAA为16.21°±3.65°,差异有统计学意义(P＜0.01);Bland-Altman结果显示对于HVA、IMA角的两种测量方法一致性较好,DMAA的测量结果一致性较差。结论 基于足部模拟负重CT图像应用Mimics软件测量拇外翻HVA、IMA、DMAA可以精准生成上述3个角的边线,进而实现角度的精确测量;重建第一跖骨远端关节面,使DMAA测量的准确度和可靠性明显优于常规X线测量法。该方法是一种可行、可靠并且精准的测量方法,为拇外翻精准化、个体化治疗提供了可靠的基础。     

三维可视化技术在Chevron手术治疗母外翻术前规划中的应用探讨

目的　探讨三维可视化技术在Chevron手术治疗母外翻术前规划中的应用价值。 方法　2014年1月至2015年12月本科室收治的20例轻度、中度母外翻患者,年龄48~72岁,行三维螺旋CT下0.625 mm薄层扫描,在M3D软件中三维图像处理系统上进行建模、模拟截骨,测量母 外翻角、第1,2跖骨间角,在不同截骨角度值下比较各测量值间的差异。 结果 数字化重建母 外翻模型、模拟截骨后按术前规划进行手术,与矫形后影像学表现进行比对,两者相符程度很高。AOFAS评分明显升高,患者满意度较高。 结论 三维重建母 外翻患者足部负重位模型可以清楚显示第1跖列在三维空间上的位置改变,为Chevron 截骨面设计,矫形后第1跖骨头的三维数据测量等提供量化依据。个性化制订母 外翻矫形手术方案,使足部形态及负重功能更好,术后患者满意度提高。     

Ludloff截骨术治疗踇外翻的三维数字模型研究

目的　建立母外翻足三维数字模型,通过模拟Ludloff截骨手术,比较术前术后各项参数的变化,预测术后疗效及并发症,为临床进行母外翻Ludloff截骨术提供一定的理论支持,尽可能降低手术风险,增加手术安全性,提高疗效。 方法　回顾性调查11例（13足）在本院足踝外科治疗的母外翻患者,模拟手术前后对三维重建模型进行母外翻角（HVA）、第1~2跖间角（IMAI~II）、第1跖骨长度、第2跖骨相对长度、第1~5跖间角（IMAI~V）等数值测量记录,并行统计学分析。 结果 模拟截骨术前后HVA分别为（35.62±6.54）°,（11.43±3.24）°;IMAI~II分别为（16.43±2.41）°,（9.12±3.18）°;第1跖骨长度分别为（63.58±4.17）mm,（59.87±3.83）mm;第2跖骨相对长度分别为（93.74±6.02）°,（86.85±5.36）°;IMAI~V分别为（29.68±3.65）°,（19.45±2.46）°。模拟手术前后上述对应指标改变有统计学意义（P<0.05）。 结论　应用三维数字模型技术对母外翻患者进行模拟Ludloff截骨术及测量相关参数,是一种可以评估Ludloff截骨效果的数字化技术,为制定手术方案提供依据。     

Ludloff截骨术治疗踇外翻的三维数字模型研究

目的　建立母外翻足三维数字模型,通过模拟Ludloff截骨手术,比较术前术后各项参数的变化,预测术后疗效及并发症,为临床进行母外翻Ludloff截骨术提供一定的理论支持,尽可能降低手术风险,增加手术安全性,提高疗效。 方法　回顾性调查11例（13足）在本院足踝外科治疗的母外翻患者,模拟手术前后对三维重建模型进行母外翻角（HVA）、第1~2跖间角（IMAI~II）、第1跖骨长度、第2跖骨相对长度、第1~5跖间角（IMAI~V）等数值测量记录,并行统计学分析。 结果 模拟截骨术前后HVA分别为（35.62±6.54）°,（11.43±3.24）°;IMAI~II分别为（16.43±2.41）°,（9.12±3.18）°;第1跖骨长度分别为（63.58±4.17）mm,（59.87±3.83）mm;第2跖骨相对长度分别为（93.74±6.02）°,（86.85±5.36）°;IMAI~V分别为（29.68±3.65）°,（19.45±2.46）°。模拟手术前后上述对应指标改变有统计学意义（P<0.05）。 结论　应用三维数字模型技术对母外翻患者进行模拟Ludloff截骨术及测量相关参数,是一种可以评估Ludloff截骨效果的数字化技术,为制定手术方案提供依据。     

微创Juvara联合Akin截骨术治疗重度母外翻的临床疗效研究

目的 探讨微创Juvara联合Akin截骨术治疗重度母外翻的临床疗效。 方法　选取2016年8月~ 2018年8月佛山市中医院骨八科治疗的重度母外翻患者45例（50足）,均采用微创Juvara联合Akin截骨术。术前、术后3个月、6个月、12个月均通过X线片测量母外翻角、跖骨间角、跖骨远端关节角、跖趾关节远端固定角、趾骨间角,参照美国足踝外科协会（AOFAS）评分和Olerud-Molander主观功能（OMA）评分标准进行测评。 结果　45例患者术后均获随访,随访时间12 ~ 17个月,平均（14.20 ± 1.55）个月,无复发病例。上述指标及评分方面,术前与术后3个月、6个月、12个月相比,差异均具有显著性意义（P<0.01）;术后3个月、6个月和12个月两两比较,差异均无显著性意义（P>0.01）。 结论 微创Juvara联合Akin截骨术治疗重度母外翻疗效确切,手术切口小,安全性高,值得临床推广应用。     

The intra- and inter-observer reliability of the physical examination methods used to assess patients with patellofemoral joint instability

BackgroundAn accurate physical examination of patients with patellar instability is an important aspect of the diagnosis and treatment. While previous studies have assessed the diagnostic accuracy of such physical examination tests, little has been undertaken to assess the inter- and intra-tester reliability of such techniques. The purpose of this study was to determine the inter- and intra-tester reliability of the physical examination tests used for patients with patellar instability.MethodsFive patients (10 knees) with bilateral recurrent patellar instability were assessed by five members of the International Patellofemoral Study Group. Each surgeon assessed each patient twice using 18 reported physical examination tests. The inter- and intra-observer reliability was assessed using weighted Kappa statistics with 95% confidence intervals.ResultsThe findings of the study suggested that there were very poor inter-observer reliability for the majority of the physical tests, with only the assessments of patellofemoral crepitus, foot arch position and the J-sign presenting with fair to moderate agreement respectively. The intra-observer reliability indicated largely moderate to substantial agreement between the first and second tests performed by each assessor, with the greatest agreement seen for the assessment of tibial torsion, popliteal angle and the Bassett's sign.ConclusionsFor the common physical examination tests used in the management of patients with patellar instability inter-observer reliability is poor, while intra-observer reliability is moderate. Standardization of physical exam assessments and further study of these results among different clinicians and more divergent patient groups is indicated.     

Three-dimensional assessment of patellofemoral anatomy: Reliability and reference ranges

BackgroundThree-dimensional (3D) imaging and analysis offer new possibilities in preoperative diagnostics and surgical planning. Simultaneous 3D analysis of the joint angles and the patellofemoral anatomy allow for a realistic assessment of bony pathologies in patients with patellofemoral complaints. This study aims to develop a standardized and validated assessment of the 3D patellofemoral morphology and to establish reference ranges.MethodsThirteen patellofemoral anatomic landmarks were defined on 3D bone models of the lower limbs based on computer tomography data and evaluated regarding inter- and intra-observer variability. Further, 60 3D models of the lower limbs of young subjects without any previous knee operation/injury were assessed and rescaled reference values for relevant patellofemoral indices were obtained.ResultsThe mean inter- and intra-observer deviation of all landmarks was below 2.3 mm. The interobserver intraclass correlation coefficient (ICC) was between 0.8 and 1.0 and the intra-observer ICC between 0.68 and 0.99 for all patellofemoral parameters. The calculated reference ranges are: Insall–Salvati index 1.0–1.4; patella tilt 6–18°; patella shift −4 to 3 mm; patella facet angle 118–131°; sulcus angle 141–156°; trochlear depth 3–6 mm; tibial-tuberosity to trochlear groove distance (TT-TG) 2D 14–21 mm; TT-TG 3D 11–18 mm; lateral trochlear inclination 13–23°; trochlear facet angle 43–65°.ConclusionThe demonstrated 3D analysis of the patellofemoral anatomy can be performed with high inter- and intra-observer correlation. Applying the obtained reference ranges and using existing 3D assessment tools for lower limb alignment, a preoperative 3D analysis and planning for complex knee procedures now is possible.     

Endobutton悬吊钢板在拇外翻畸形中的新应用

背景:拇外翻是一种复杂的畸形,尚无治疗金标准,截骨治疗目前得到推崇,但并发症较多,能否进行不截骨矫正拇外翻是作者所在课题组进行的一项新尝试。目的:探讨Endobutton钢板悬吊固定治疗拇外翻畸形的效果。方法:2013年4月至2018年8月苏州大学附属常州肿瘤医院骨科采用Endobutton钢板悬吊固定治疗拇外翻26足,不截骨。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。术前、术后测量拇外翻角及第1,2跖骨间角,术后12个月评估美国足踝外科协会评分。结果与结论:①所有患者均获满意随访,随访周期8-38个月;②术后患者拇外翻角[(14.15±3.60)°vs.(28.95±4.12)°,P<0.01]及第1,2跖骨间角均显著小于术前[(7.88±0.90)°vs.(15.82±1.81)°,P<0.01]:③术后12个月患者美国足踝外科协会评分为(89.15±7.81)分,显著高于术前(62.08±7.10)分(P<0.01);④提示Endobutton钢板悬吊固定第1,2跖骨间是治疗拇外翻是一种可行的方案。     

The Genovese grading scale is not reliable for MR assessment of collagen meniscus implants

Background

The purpose of the study was to evaluate the intra- and inter-observer reliabilities of the Genovese grading on MRI in patients after collagen meniscus substitution.

拇外翻术后拇外翻角和第1-2跖骨间角X射线测量方法评价

背景：拇外翻术后拇外翻角和第1-2跖骨间角的测量关键在于第1跖骨轴线的确定。第1跖骨轴线的不同确定方法,造成了这两个角度测量值的差异,使不同临床研究之间的数据不具有可比性。对于拇外翻术后角度测量,国内外尚未形成公认的标准方法。 目的：回顾不同拇外翻术后拇外翻角和第1-2跖骨间角的测量方法的研究进展,为拇外翻的术后测量与评价研究提供参考。 方法：由第一作者在2012年2月检索PubMed、中国期刊全文数据库以及万方数据库。其中,英文检索词为：“hallux valgus”、“angles”、“radiographic measurements”。中文检索词为“拇外翻”、“角度”、“X射线测量”。选取29 篇文献进行归纳总结。 结果与结论：最好的测量方法其标记点必须是易于确定,可重复性好,应尽量避免受到截骨部位及跖骨本身解剖变异的影响。拇外翻术后X射线测量方法目前多用头部中心/基底部中心测量方法。专业化的工具软件测量取代手工测量是未来拇外翻术后X射线测量的发展趋势。     

The reliability of the patellotrochlear index on magnetic resonance imaging for measuring patellofemoral height

BackgroundThe purpose of this study was to determine the inter- and intra-observer reliability of the patellotrochlear index (PTI) on magnetic resonance images (MRI) in patients with patellofemoral pain. The correlation between the PTI measured on MRI and the modified Insall–Salvati (MIS) ratio measured on radiographs was also assessed.MethodsThe PTI was assessed on MRI images and the MIS ratio on radiographs of 66 knees of 62 patients. Assessment was performed by two orthopaedic surgeons, one orthopaedic surgery registrar, two radiologists and one radiology registrar. Correlation coefficients, standard errors of measurement and limits of agreement were calculated for the PTI. To assess the association between the PTI and the MIS ratio, the Pearson's correlation coefficient was calculated.ResultsThe PTI showed good interobserver reliability (intraclass correlation coefficient (ICC) 0.79; 95% confidence interval (CI) 0.73–0.85) and excellent intra-observer reliability (ICC 0.90; 95% CI 0.89–0.91). The standard error of measurement was 0.05 and limits of agreement with the mean ± 0.09. A very weak and not significant correlation was found between the PTI and the MIS (r = 0.02; P = 0.77).ConclusionsThe PTI showed good interobserver reliability and excellent intra-observer reliability. In order to conclude which measurement method of assessing patellar height is truly the most reliable, future studies should investigate agreement parameters (standard error of measurement, limits of agreement) besides solely correlation coefficients. We found a very weak correlation between the PTI and the MIS which suggests that at least one index has poor validity. Future validity studies on indices to assess patellar height are necessary.     

MRI analysis for rotation of total knee components

PurposeThe aim of this study was to analyze rotation of total knee (TKA) implant components using magnetic resonance imaging (MRI) and to assess the reproducibility of results. It was hypothesized that rotation of both femoral and tibial implants would be reliably reproduced.MethodsA retrospective analysis of 55 MRI studies in subjects with painful TKA implants was conducted. There were 27 zirconium and 28 cobalt/chrome/molybdenum alloy (CoCrMo) femoral components in the group. The rotation angle of femoral and tibial components was measured and determined. Statistical analysis included tests for reliability, variance between implant groups, standard deviations and confidence intervals.ResultsThere was a sufficient inter- and intra-observer reliability determined for rotation in all implants. The inter-observer reliability was notably higher in the zirconium femur group with significant less variance and lower standard deviations than the CoCrMo femoral component comparison group. Standard deviations for femoral rotational analysis were within a clinically acceptable range. The standard deviations were considerably higher in the tibial component rotational analysis.ConclusionMRI analysis of the rotation of femoral implants after TKA allows good reproducibility, especially with review of zirconium implants. There is less reproducibility for tibial components related to the applied geometric method to quantify rotation and not to the MRI technique.     

迷你双螺纹空心钉结合截骨治疗拇外翻

背景：拇外翻畸形矫正方式多样,采用迷你双螺纹空心钉材料结合截骨矫形的方式损伤小,能够满足拇外翻矫形的目的,是临床上新型的微创生物型内固定材料。 目的：回顾性分析迷你双螺纹空心钉材料应用于截骨矫形拇外翻治疗中的临床疗效。 方法：选择拇外翻畸形患者30例,其中双侧矫形患者8例,单侧矫形患者22例。根据自愿均采用第一跖骨截骨矫形迷你双螺纹空心钉内固定,治疗前后拍摄X射线片测量外翻角、跖间角、籽骨位置,进行AOFAS评分,并计算第一跖骨短缩长度。 结果与结论：采用迷你双螺纹空心钉结合截骨矫形治疗后,拇外翻畸形患者的外翻角、跖间角、AOFAS评分及籽骨位置较治疗前明显改善,第一跖骨短缩在矫形可控范围内避免畸形复发及跖骨痛。     

髋关节发育不良伴股骨前倾角异常增大成人患者联合截骨术的疗效

目的 对比年龄≥30岁伴股骨前倾角异常增大（>40°）髋关节发育不良患者（developmental dysplasia of the hip, DDH）接受髋臼周围截骨术（periacetabular osteotomy, PAO）联合股骨近端去旋转截骨术（derotational osteotomy, PFDO）与单纯PAO的手术效果。方法 选取2012年1月至2020年1月在解放军总医院第四医学中心骨科医学部接受PAO联合PFDO的年龄≥30岁伴股骨前倾角异常增大（>40°）的DDH患者,共计55例,按照接受手术方式不同,分为联合手术组（n=29）和PAO组（n=26）。联合手术组接受PAO联合PFDO治疗,PAO组仅接受PAO治疗。比较两组患者的LCEA、ACEA、T?nnis角术前及术后1年的差异,比较两组患者术前、术后6个月、术后1年及末次随访（>2年）的改良Harris评分和iHot-12评分。结果 共计随访55例患者,随访时间为2年1个月～9年11个月。术后6个月,联合手术组与PAO组的改良Harris评分和iHot-12评分相近（P>0.05）...     

Reliability of computed tomography measurements in assessment of thigh muscle cross-sectional area and attenuation

Background  

Advancement in technology of computer tomography (CT) and introduction of new medical imaging softwares enables easy and rapid assessment of muscle cross-sectional area (CSA) and attenuation. Before using these techniques in clinical studies there is a need for evaluation of the reliability of the measurements. The purpose of the study was to evaluate the inter- and intra-observer reliability of ImageJ in measuring thigh muscles CSA and attenuation in patients with anterior cruciate ligament (ACL) injury by computer tomography.     

Mid inter-epicondyle trochlea intersection (MIELTI): Proposal of a new index for identifying the deepest part of the trochlea

BackgroundTibial tuberosity trochlear groove distance (TT-TG) is an important radiological measurement in patellofemoral instability (PFI). Where instability is recurrent, a value ≥ 20 mm is considered an indication for tubercle medialisation. Trochlear dysplasia commonly accompanies PFI. It can make identification of the deepest part of the trochlea difficult, which makes the TT-TG difficult or impossible to assess. To address this, we propose a new method of identifying the deepest part of trochlea based on the femoral epicondyles. It is named the tibial tuberosity mid inter-epicondyle trochlea intersection distance (TT-MIELTI).MethodsThe TT-TG and TT-MIELTI of 30 consecutive non-dysplastic knee MRIs were compared, excluding 96 knees with dysplasia, sulcus angles ≥ 135°, a tibial tuberosity anterior cortex which was not fully demonstrated, artefact, fracture, or Osgood Schlatter's disease. To assess inter-observer reliability three blinded researchers measured the TT-TG and the TT-MIELTI of all 30 knees. To assess intra-observer repeatability one researcher repeated the measurements after six weeks.ResultsThe intraclass correlation coefficient (ICC) test demonstrated good to excellent values for all measurements (TT-TG and TT-MIELTI correlation ICC 0.94–0.97; TT-TG inter-observer reliability ICC = 0.85, intra-observer repeatability ICC = 0.90; TT-MIELTI inter-observer reliability ICC = 0.86, intra-observer repeatability ICC = 0.89. All p values < .001.)ConclusionsIn non-dysplastic knees the mid inter-epicondyle trochlea intersection (MIELTI) accurately identifies the deepest part of the trochlea, and TT-MIELTI is a reliable alternative to the TT-TG. Re-assessment in dysplastic knees would be of benefit to establish its usefulness in the clinical setting.     

Measurement techniques to determine tibial rotation after total knee arthroplasty are less accurate than we think

Background

The present study assessed the inter- and intra-observer reliability of tibial and femoral rotation measures after total knee arthroplasty (TKA), and evaluated the correlation between these measurement techniques and their clinical relevance.

女性外翻引发籽骨嵴磨损的影响因素分析

Objective To explore the risk factors influencing the intersesamoidal crista erosion infemale patients with hallux valgus.Methods Symptomatic female hallux valgus patients who underwent a weightbearing CT scan were reviewed from October 2017 to June 2018. A total of 144 patients (237 feet) aged 19-84 years (53.79±13.04) were included in the study. Two groups were identified by whether or not the inersesamoidal crista eroded. Parameters about hallux valgus included age, inter-metatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), tibial sesamoid grading on dorsoplantar view, coronal plane sesamoid grading, first metatarsal rotation angle (α angle), and first metatarsal bottom rotation angle (β angle). The two groups of data were compared by Student's t-test, Wilcoxon rank test, or chi-square test according to data type and distribution. Parameters that had significant differences were included in the logistic regression by the forward model, and risk factors of intersesamoidal crista erosion were calculated. Receiver operating characteristic (ROC) analysis was then used to determine the cut-off values.Results The 144 (237 feet) patients showed an IMA of 13.85°±3.15°, an HVA 31.52°±11.23°, a DMAA of 18.10°±8.08°, an α angle of 22.78°±6.89°, and a β angle of 15.01°±6.45°. Only the β angle had no statistical difference (Z=-1.171, P>0.05), and all other parameters were statistically significant (all P values<0.05). Logistic regression results showed that age [(OR(95% CI): 1.05(1.02-1.09), P＜0.01)] and coronal plane sesamoid grading [(OR(95% CI): 4.41(2.90-6.70), P<0.01)] were the risk factors for intersesamoidal crista erosion. ROC calculation showed that the cut-off value of age was 53.5 years old (sensitivity 85.1%, specificity 56.6%), and that of coronal plane sesamoid grading was 1.5 (sensitivity 90.4%, specificity 67.8%).Conclusions The intersesamoidal crista erosion in female patients with hallux valgus is affected by age and coronal plane sesamoid grading but not by IMA, HVA, DMAA, sesamoid grading on the dorsoplantar plane and first metatarsal rotation angle.