传统与改良Chevron截骨术联合外侧软组织松解治疗轻中度足母外翻畸形的疗效比较

目的 比较传统Chevron截骨术（traditional Chevron osteotomy,TCO）与改良Chevron截骨术（modified Chevron osteotomy,MCO）联合外侧软组织松解治疗轻中度足母外翻畸形的临床疗效。方法 选取2021年1月至2022年12月于湖北省中西医结合医院行手术治疗的31例轻/中度足母外翻病人,其中女27例,男4例,平均年龄为46.5岁（31~62岁）。左足17例,右足14例。根据手术方式分为TCO组（16例）与MCO组（15例）。记录病人术前及术后6周、1年随访时足母外翻角（hallux valgus angle,HVA）、跖骨间角（intermetatarsal angle,IMA）、跖趾关节活动度（range of motion,ROM）、美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society,AOFAS）踝与后足功能评分、疼痛视觉模拟量表（visual analogue scale,VAS）评分和术后满意度。结果 两组病人术后HVA、IMA、ROM、AOFAS、VAS均较术前改善（P＜0.05）。组间比较,MCO组AOFAS评分、VAS评分优于TCO组（P＜0.05）。术后6周两组间ROM比较,差异有统计学意义（P＜0.05）,1年随访时差异无统计学意义（P＞0.05）。两组间HVA及IMA未发现统计学差异（P＞0.05)。结论 TCO和MCO手术均可改善轻中度足母外翻畸形症状,矫正关节畸形,消除疼痛,恢复正常行走,临床疗效至少持续一年。     

Comparison between Pin Fixation and Combined Screw Fixation in Proximal Chevron Metatarsal Osteotomy for Hallux Valgus Deformity Correction

BackgroundProblems associated with hallux valgus deformity correction using Kirschner-wire (K-wire) fixation include pin pullout and loss of stability. These complications are pronounced in the osteopenic bone, and few reports have focused on pin versus screw fixation. We examined the use of additional screw fixation to avoid these problems. The aim of this study was to compare outcomes of K-wire fixation (KW) and a combined K-wire and screw fixation (KWS).MethodsTwo groups with hallux valgus deformity, who were treated with a proximal chevron metatarsal osteotomy (PCMO), were compared based on the fixation method used. The KW group included 117 feet of 98 patients, and the KWS group included 56 feet of 40 patients. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) hallux score, and patient satisfaction score were evaluated. Radiographically, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured.ResultsThe mean VAS score decreased from 6.3 preoperatively to 1.6 postoperatively in the KW group and from 5.7 preoperatively to 0.5 postoperatively in the KWS group (p < 0.001). The mean AOFAS scores of the KW and KWS groups improved from 59.4 and 58.2, respectively, to 88.9 and 95.3, respectively (p < 0.001). Eighty-five percent in the KW group and 93% in the KWS group were satisfied with surgery. Clinical differences were not significant. The mean HVAs decreased from 34.7° to 9.1° in the KW group and from 38.5° to 9.2° in the KWS group (p < 0.001). The mean IMA decreased from 14.5° (range, 11.8°–17.2°) to 6.4° (range, 2.7°–10.1°) in the KW group and from 18.0° (range, 14.8°–21.2°) to 5.3° (range, 2.5°–8.1°) in the KWS group (p < 0.001). When IMA values at the 3-month postoperative and the final follow-up were compared, the IMA was significantly increased only in the KW group (p < 0.001) and no difference was found in the KWS group (p = 0.280).ConclusionsWe found a statistically significant difference in the decrease in IMA between the 2 groups. We recommend the combined pin and screw fixation in PCMO to enhance fixation stability and prevent potential hallux valgus correction loss.     

Comparison of Clinical and Radiological Outcomes Between Upper Fibular Curvature and Non‐Curvature with Medial Knee Osteoarthritis Following Proximal Fibular Osteotomy: A Retrospective Cohort Study with Minimum 2‐Year Follow‐up

ObjectiveTo evaluate and compare the clinical and radiographic outcomes of proximal fibular osteotomy (PFO) in treating medial knee osteoarthritis (KOA) patients with upper fibular curvature and non‐curvature.MethodsA retrospective cohort study was performed. From January 2016 to January 2017, a total of 51 patients (nine males and 42 females) at a mean age of 63.7 years (range 48–79 years) with medial KOA who underwent PFO procedure at the Third Hospital of Hebei Medical University were included in the study. The patients were divided into the two groups, namely curvature group (28 patients, six males and 22 females, aged 62.6 ± 7.7 years) and non‐curvature group (23 patients, three males and 20 females, aged 64.5 ± 7.6 years). Perioperative parameters and Kellgren‐Lawrence classification were recorded and analyzed in the two groups, respectively. All patients were followed up at 1, 3, 6, and 12 months at the first year of post‐operation, and then every 6 months from the second year of post‐operation. A telephone survey with standard questionnaire survey, including Visual Analog Scale (VAS) score and Hospital for Special Surgery (HSS) scoring system, was used to evaluate postoperative clinical outcomes. Radiological results were assessed using the femorotibial angle (FTA), hip‐knee‐ankle angle (HKA), and settlement value of medial tibial platform (MTP) in the two groups.ResultsThe average follow‐up periods of the curvature group and the non‐curvature group were 34.8 ± 6.1 and 33.9 ± 5.4 months, respectively. There were no significant differences between the two groups of demographic data in terms of number of patients, age, body mass index (BMI), gender, KOA side, and Kellgren‐Lawrence classification (P > 0.05). The VAS scores of the curvature group and non‐curvature group were (3.53 ± 1.62 vs 3.68 ± 1.43 at 1 month, 3.46 ± 0.79 vs 3.57 ± 0.66 at 3 months, and 2.43 ± 0.88 vs 2.83 ± 0.94 at 6 months, both P > 0.05), while significant differences were found from 12 months post‐operation (1.54 ± 0.72 vs 2.03 ± 0.85 at 12 months, and 1.04 ± 0.69 vs 1.74 ± 0.75 at 24 months, both P < 0.05). The HSS scores of the curvature group and non‐curvature group were (79.67 ± 5.14 vs 78.25 ± 6.37 at 1 month, 84.65 ± 3.76 vs 83.18 ± 3.64 at 3 months, and 86.27 ± 3.13 vs 85.49 ± 3.25 at 6 months, both P > 0.05), while significant differences were found from 12 months post‐operation (90.64 ± 4.32 vs 87.71 ± 5.63 at 12 months, and 92.93 ± 2.07 vs 90.06 ± 2.08 at 24 months, both P < 0.05). In addition, the FTA and settlement value of the curvature group were lower than the non‐curvature group (177.18 ± 1.52 vs 178.35 ± 1.86, and 5.29 ± 1.74 vs 6.49 ± 2.09, both P < 0.05) while the HKA were higher than the non‐curvature group (175.32 ± 2.34 vs 173.83 ± 2.64, P < 0.05) at the final follow‐up.ConclusionsMedial KOA patients with upper fibular curvature is an optimal surgical indication for PFO surgery, with the advantages of pain relief, better functional recovery, and alignment correction.     

Progressive Adolescent Idiopathic Cervical Kyphosis Secondary to Constant Postural Neck Flexion Reading Habit with a 10‐year Follow‐up: Case Report and Literature Review

BackgroundAlthough it has been established that adolescent idiopathic cervical kyphosis (AICK) has no known cause, there are associated risk factors. However, the underlying causes remain puzzling. This case report presents severe AICK linked to chronic neck flexion postural habit, treated with combined anterior and posterior correction surgery and review of the literature.Case presentationA 16‐year‐old male with no history of trauma, surgery, or family history of spinal deformity complained of intolerable neck pain and rigidity. He developed an incessant reading of comic books at a very young age, and he preferred placing the book on the floor with his head flexed between his thighs. Acupuncture and massage therapy failed to relief symptoms. He had no neurological symptoms on examination and X‐ray showed Cobb angle of 70.5°. MRI and CT scans showed no spinal cord compression or osteophyte formation. A combined anterior and posterior correction surgery was performed after a week of skull traction. The deformity was corrected, neck pain disappeared, and neck rotatory function maintained after posterior implant removal. The maximum follow‐up was 10 years.ConclusionsThe potential underlying risk factor observed in this case is unusual. Chronic neck flexion postural habit is a potential risk factor of severe AICK in some individuals.