Hallux valgus in the younger patient: the structural abnormality.

Standardised radiographs of the weight-bearing foot were analysed in fifty young patients undergoing osteotomy of the first metatarsal for hallux valgus. True metatarsus primus varus was not found more frequently than in a control series. The intermetatarsal angle was significantly greater in affected feet compared with controls. The structural abnormality in hallux valgus in the young is therefore due to a valgus disposition of the second and subsequent metatarsals, rather than varus inclination of the first metatarsal.     

Correction of metatarsus primus varus associated with hallux valgus deformity using the arthrex mini tightrope: a report of 44 cases

Metatarsus primus varus must be addressed during correction of moderate to severe hallux valgus deformity. As an alternative to proximal osteotomy or first tarsometatarsal fusion for hallux valgus correction, this study presents a series of patients treated using the Arthrex Mini TightRope. A total of 36 patients (44 operations) with hallux valgus and metatarsus primus varus underwent correction using the Arthrex Mini TightRope. Assessment included measurement of radiographic parameters, the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot outcomes score, and the SF-12. The average hallux valgus angle improved from 32.2° to 15.2° (P < .0001). The average first intermetatarsal angle improved from 14.6° to 8.2° (P < .0001). The average distal metatarsal articular angle improved from 17.0° to 9.6° (P < .0001). The average AOFAS midfoot outcomes scores improved from 45.44 to 84.72 (P < .0001). Postoperative SF-12 physical and mental scores averaged 52.99 and 56.63. Only one patient had recurrence of deformity. Correcting metatarsus primus varus in association with hallux valgus deformity using the Arthrex Mini TightRope should be considered a treatment option. This technique is less invasive and seems capable of maintaining correction while allowing for early weight bearing and avoiding the need for a proximal first metatarsal osteotomy or Lapidus procedure.     

Degenerative osteoarthrosis of tarsometatarsal joints in hallux valgus: a radiographic study

To clarify the pathogenesis of degenerative osteoarthrosis of the tarsometatarsal joints in hallux valgus, we evaluated dorsoplantar and lateral radiographs during weight-bearing in 16 patients (25 feet) with hallux valgus accompanied by degenerative osteoarthrosis of the tarsometatarsal joints and 25 controls (25 feet) with hallux valgus alone. The proximal second metatarsal articular angle (a parameter we devised), the hallux valgus angle, intermetatarsal angle, metatarsal length, sesamoid displacement, calcaneal pitch, and foot length were measured and then evaluation using a mapping system was performed. There were no significant differences in the hallux valgus angle, intermetatarsal angle, sesamoid displacement, calcaneal pitch, or foot length. In the presence of degenerative osteoarthrosis of the tarsometatarsal joints, the second, third, and fourth metatarsals were long, and a large inclination of the proximal articular surface of the second metatarsal and adduction of the first to fourth metatarsals were observed. These findings appeared to be involved in the development of this disorder.     

Proximal spherical metatarsal osteotomy for the foot with severe hallux valgus

BACKGROUND: A proximal spherical metatarsal osteotomy was devised to correct not only varus deviation of the first metatarsal, but also dorsiflexion. We expected to increase the medial longitudinal arch by adding plantar flexion at the osteotomy site. To investigate the limitations of this procedure for feet with severe hallux valgus, a followup study was performed on patients with preoperative hallux valgus angles greater than or equal to 40 degrees. MATERIALS AND METHODS: Forty-eight feet in 37 patients (10 male, 27 female) (60 years; range, 20 to 84 years) were investigated. Mean followup was 4 years and 1 month, ranging from 2 to 8 years. The spherical osteotomy was performed using a curved chisel. A distal soft tissue procedure was done at the same time. Twenty feet received combined operations for their combined deformities. RESULTS: While 81% of patients were satisfied with the results, 50% of those with preoperative hallux valgus angles greater than or equal to 50 degrees had postoperative hallux valgus angle greater than or equal to 20 degrees. In these patients, correction of metatarsus primus varus was good, but correction of valgus deviation of the hallux was fair. Mean correction toward plantar flexion was 1.5 degrees and no increase in arch height was achieved. CONCLUSION: The proximal spherical osteotomy could consistently achieve satisfactory results for the patients with hallux valgus angles less than 50 degrees. However, the corrections were worse in feet with more severe deformities. Furthermore, plantarflexion at the osteotomy site was offset by displacement at the first tarsometatarsal joint. If plantarflexion is indispensable, arthrodesis of the tarsometatarsal joint is recommended.     

经皮微创截骨术联合8字绷带和分趾垫外固定治疗中度拇外翻

目的:探讨经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻的临床疗效。方法:自2019年8月至2021年1月采用经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻患者23例,失访1例,最终纳入22例(30足),男4例6足,女18例24足,年龄27～66 (50.59±11.95)岁。比较术前和术后6个月患足拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),跖骨跨度(第1、5跖骨头之间的距离)和软组织宽度变化情况,并采用美国足踝外科协会踝-后足评分标准(American Orthopaedic Foot and Ankle Society,AOFAS)进行临床疗效评价,采用视觉模拟评分(visual analogue scale,VAS)评价足部自觉疼痛情况。结果:22例患者获得随访,时间5.7～6.4(6.13±0.85)个月。患者第1跖骨截骨处均获得骨性愈合,足趾外观畸形得到纠正,术后患足未出现跖骨头缺血性坏死、转移性跖骨痛等并发症。术后6个月患足HVA、IMA、跖骨跨度、软组织宽度、...     

Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal soft-tissue release

Between 1991 and 1995, 96 patients (114 feet) were treated with a proximal crescentic metatarsal osteotomy and distal soft-tissue procedure for moderate to severe hallux valgus deformity [intermetatarsal (IM) angle > 15°, or hallux valgus (HV) angle > 30°]. At an average follow-up of 26 months, 8 men and 62 women (86 feet) with a mean age of 53.2 years were retrospectively reviewed. The HV angle averaged 41.1° preoperatively and 14.6° postoperatively. The respective values for the IM angle were 17.8° and 7.8°. Neither the average metatarsal shortening of 3 mm nor the dorsal angulation at the osteotomy site seen in 9% of cases evidenced any clinical significance at follow-up. Patient satisfaction was excellent or good in 91%, and the mean Mayo Clinic Forefoot Score (total 75 points) improved from 37.2 to 61.1 points. Complications included 8 cases of hallux varus and 5 cases of hardware failure. Based on this first study exclusively focusing on moderate to severe hallux valgus deformity, we conclude that proximal first metatarsal osteotomy in combination with a lateral soft-tissue procedure is effective in correcting moderate to severe symptomatic hallux valgus deformity with metatarsus primus varus (IM angle > 15° or HV angle > 30 °). Received: 28 July 1999     

第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻

目的 :探讨第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻的临床疗效。方法:自2015年6月至2017年6月,采用第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻32例(40足),其中男3例3足,女29例37足;年龄22～80岁,平均57.57岁;病程2～32年,平均14年;轻度9足,中度31足。术前患者合并拇囊炎,伴有第1跖趾关节周围疼痛并存在负重行走时疼痛加重。手术前后拍摄足负重正侧位片,比较拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),并采用美国足踝外科协会拇外翻评分(AOFAS)评价临床疗效。结果:32例患者获得了随访,时间12～24个月,平均15.2个月。术后切口均愈合良好,无感染、跖骨头坏死等并发症发生。术前HVA、IMA分别由(32.08±5.59)°、(11.63±2.24)°减小至术后12个月的(10.31±4.36)°、(5.02±2.34)°,差异有统计学意义(P0.05)。AOFAS评分由术前的56.75±6.42提高至术后12个月的88.80±3.99 (P0.05)。结论:第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻畸形可获得较好的临床效果,为拇外翻治疗提供了更多的选择。     

Radiographic analysis of metatarsus primus varus: 45 feet followed 15 months after distal metatarsal osteotomy and lateral soft-tissue release

We analyzed standardized radiographs of 45 feet in 41 patients with symptomatic hallux valgus and an intermetatarsal angle of 17 (15-23) degrees 15 (9-24) months after distal metatarsal osteotomy and lateral soft-tissue releases. A mean reduction in the ll-intermetatarsal angle of 12 degrees and hallux valgus angle of 24° was found. On average, the metatarsus primus varus angle improved by 4 degrees, the l-intermetatarsal angle by 3 degrees and the inclination angle of the first cuneiform by 4 degrees. We conclude that this operation corrects the metatarsus primus varus, without substantially altering the alignment of the long axis of the first metatarsal.     

Proximal crescentic metatarsal osteotomy: the effect of saw blade orientation on first ray elevation

BACKGROUND: Moderate and severe hallux valgus deformities generally require a proximal metatarsal osteotomy to correct a widened intermetatarsal angle. Although excellent results have been reported using the proximal crescentic osteotomy, concerns have been raised about the incidence of postoperative dorsal malunion, which may lead to transfer lesions. The objectives of this paper were to evaluate the influence of saw blade angulation on the final position of the first metatarsal and to test a new technique used to ensure proper orientation of the osteotomy. METHODS: For part I of the study, 26 Sawbones specimens with hallux valgus deformities were corrected using a proximal crescentic osteotomy with the saw blade position incrementally rotated in the coronal plane. The sagittal change in the final position of the metatarsal was quantified radiographically and correlated to the saw blade orientation. For part II of the study, a Kirschner wire was placed in a vertical position into the medial cuneiform to serve as a guide for the crescentic saw blade in 13 cadaver feet with hallux valgus. Metatarsus primus elevatus was measured after surgical correction. RESULTS: Part I of the study demonstrated a highly linear relationship (R2=0.95) between first metatarsal elevation and the orientation of the saw blade. Every 10-degree of saw blade angulation resulted in a 2-mm change in the sagittal position of the first metatarsal. In part II of the study, the average change in metatarsus primus elevation for the 13 specimens after surgical correction of the hallux valgus deformity was only 1.1 mm (range -3.9 to +4.9 mm). Eleven of the 13 specimens had less than 2.5 mm of elevatus. CONCLUSION: Dorsal malunion of the first metatarsal after proximal crescentic osteotomy is a recognized complication. The final position of the hallux metatarsal is influenced by the coronal plane orientation of the saw. A new technique is described to aid the surgeon in proper alignment of the saw and help prevent excessive first ray elevation.     

Bunion surgery using locking-plate fixation of proximal metatarsal chevron osteotomies

BACKGROUND: Symptomatic large hallux valgus deformities commonly require surgical intervention with a proximal metatarsal osteotomy. A number of fixation methods have been described for proximal chevron osteotomies; one of the most recent is locking plates. METHODS: We retrospectively reviewed the records of 16 consecutive patients (20 feet) with severe bunion deformities who had locking-plate fixation of proximal chevron osteotomies. Clinical evaluation focused on osteotomy healing, transfer lesions, and hardware-related complications. Preoperative and postoperative radiographic evaluation included the hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), medial 1-2 intermetatarsal distance (MIMD; the amount of narrowing of the foot), sesamoid position, first metatarsal elevation, and metatarsal length change. A postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was obtained in all patients. RESULTS: The average radiographic improvements were HVA, 16.0 degrees, IMA, 7.6 degrees, and MIMD, 9.0 mm. Sesamoid position improved in 16 of 20 feet. First metatarsal elevation averaged 0.8 degrees, and the average metatarsal shortening was less than 1 mm. The AOFAS score averaged 94.1 points. Two complications were unrelated to plate fixation. CONCLUSIONS: The locking plate held alignment and position of the first ray after chevron osteotomy without clinical evidence of transfer lesions or hardware-related symptoms. Locking plates may improve stability of the proximal metatarsal after a chevron osteotomy for correction of hallux valgus.     

Surgical treatment of severe hallux valgus: the state of practice among academic foot and ankle surgeons

BACKGROUND: The purpose of this study was to evaluate the operative procedures used for treatment of severe hallux valgus by academic foot and ankle surgeons practicing in the United States. METHODS: A patient with severe hallux valgus deformity was developed as a hypothetical case: a 50-year-old woman with a severe deformity (intermetatarsal angle = 20 degrees; hallux valgus angle = 42 degrees). The patient was symptomatic with pain, did not improve with conservative measures, and wanted the deformity corrected. This case was sent to academic foot and ankle surgeons in a survey to determine their preferred operative treatment for this case. The overall response rate was 84% (128 of 153). To be included in the study group each surgeon had to have 1) foot and ankle patients comprising 50% or more of his clinical practice and 2) direct responsibility for teaching orthopaedic residents. One hundred and five respondents met the inclusion criteria and formed the study group; however, three surveys with invalid responses were deleted. RESULTS: Fifty-two percent (54 of 102) of the respondents chose a metatarsal osteotomy, 26% (26 of 102) a first metatarsophalangeal (MTP) joint arthrodesis, and 24% (24 of 102) a Lapidus procedure. Two respondents chose both an arthrodesis and a metatarsal osteotomy. Among the 54 respondents who chose metatarsal osteotomies, 24 used a Ludloff, 16 a proximal crescentic, eight a proximal chevron, two a scarf, two a distal chevron, and two other. In addition, secondary procedures to enhance the correction included a Weil osteotomy in 46% (47 of 102) and an Akin osteotomy in 30% (31 of 102). CONCLUSIONS: There was a wide variation in the type of procedure used to correct this severe hallux valgus deformity; approximately 50% of the respondents chose a metatarsal osteotomy, 25% chose a first MTP joint arthrodesis, and 25% a Lapidus procedure.     

The effect of first ray shortening in the development of metatarsalgia in the second through fourth rays after metatarsal osteotomy

BACKGROUND: The aims of this study were to determine the severity of metatarsalgia of the second through fifth rays after shortening of the first ray for correction of hallux valgus deformity and patient satisfaction of the cosmetic results. METHODS: Two hundred and forty metatarsal osteotomies (Wilson osteotomy as modified by Lindgren and Turan) were evaluated 4.19+/-1.29 years postoperatively. The procedure involved a slightly oblique subcapital osteotomy of the first metatarsal and fixation with one screw. RESULTS: The average decrease in the hallux valgus angle was 26+/-5 degrees, the 1-2 intermetatarsal angle was 8.4+/-4 degrees, and the average shortening of the first metatarsal was 3.8+/-1.8 mm. Positive correlations were found between metatarsalgia of the second through fourth rays and first ray shortening (p<0.001 second ray, p<0.001 third ray, and p<0.001 fourth ray); there was no correlation between the fifth ray and first ray shortening. No correlation was found between a decrease in the hallux valgus angle or 1-2 intermetatarsal angle and metatarsalgia in the second through fifth rays. A positive correlation was detected between postoperative foot alignment and decrease in the hallux valgus (p<0.001) and a negative correlation between postoperative foot alignment and first ray shortening (p<0.01). No correlation was noted between postoperative foot alignment and the 1-2 intermetatarsal angle. CONCLUSION: Excessive shortening of the first metatarsal should be avoided to decrease the occurrence of postoperative transfer metatarsalgia. We found a greater patient satisfaction with foot alignment in patients who had a greater decrease in the hallux valgus angle and less shortening of the first ray.     

Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up.

We retrospectively reviewed the results for seventy-five patients (109 feet) in whom a hallux valgus deformity had been corrected with the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and proximal crescentic osteotomy of the first metatarsal. The patients were followed for an average of thirty-four months (range, twenty-four to fifty-six months). The preoperative hallux valgus angle averaged 31 degrees, and the postoperative angle averaged 9 degrees. The preoperative intermetatarsal angle averaged 14 degrees and the postoperative angle, 6 degrees. Ninety-three per cent of the patients were satisfied with the result of the procedure. They stated that, given the same circumstances, they would have the operation again. The most common complication was hallux varus, which occurred in thirteen feet (nine patients). The other complications included recurrence of the hallux valgus in two feet, pain under a fibular sesamoid in one foot, and a tailor's bunion that was unrelated to the operation in one foot. Only five of forty-eight feet that had had a symptomatic plantar keratosis beneath the second metatarsal head preoperatively remained symptomatic postoperatively.     

Reverdin手术联合第一跖骨近端截骨治疗(足母)外翻

目的 :探索一种治疗外翻效果较满意的术式。方法 :作者对外翻的传统术式进行了思考 ,运用Reverdin手术联合第一跖骨近端截骨治疗外翻。自 1997年 10月～ 2 0 0 0年 9月 ,13例患者 ,2 1足接受此种手术治疗。术中常规松解软组织及切除内侧骨赘后 ,以Reverdin术式对跖骨头内翻截骨校正近端关节固定角 ,第一跖骨近端外翻截骨校正跖骨内翻畸形。结果 :随访 6个月～ 3年半 ,优 9例 16足 ,良 3例 4足 ,差 1例 1足 ,优良 95 .2 % ,无跖骨头坏死和截骨处不愈合。术前外翻角平均 3 5° ,术后为 11° ,第一跖骨间角术前平均 19° ,术后为 5 .8° ,近端关节固定角术前平均18° ,术后为 2°。结论 :外翻矫形应根据畸形情况及其病理改变选择手术方式。本手术方式矫形满意 ,但需严格掌握其手术适应证。     

Radiographic Outcomes Following Primary Arthrodesis of the First Metatarsophalangeal Joint in Hallux Abductovalgus Deformity

The purpose of this study was to evaluate the radiographic outcomes of primary metatarsophalangeal joint arthrodesis for hallux abductovalgus deformities. Between January 2004 and March 2009, 56 consecutive patients (58 feet) underwent primary arthrodesis of the metatarsophalangeal joint (MTPJ) for severe hallux abductovalgus deformity and or hallux rigidus. Results were assessed by primary radiographic outcome measurements (hallux valgus and first-second intermetatarsal angle). Overall, the mean hallux valgus (HA) angle improved significantly from 31.9° to 13.4° (P < .01). The mean first-second intermetatarsal (IM) angle correction was also signficantly reduced from 14.0° to 9.7° (P < .01). When separated by deformity group (mild, moderate, and severe), the mean hallux valgus and first-second intermetatarsal angles demonstrated statistically significant correction in all groups when comparing preoperative and postoperative values (P < .01). Primary arthrodesis provides predictable radiographic outcomes and effective correction for patients with differing severity of hallux abductovalgus deformity and arthritis of the first metatarsophalangeal joint. A separate proximal osteotomy for severe metatarsus primus varus correction may not be necessary because of the correction achieved at the metatarsophalangeal joint arthrodesis level. The results of this study demonstrate that as the severity of the preoperative deformity increases, the amount of postoperative radiographic (HA and IM angle measurement) correction after MTPJ arthrodesis will improve correspondingly.     

The modified Ludloff osteotomy for correction of severe metatarsus primus varus with hallux valgus deformity

AIM: The present study investigates the clinical and radiological mid-term results of the modified Ludloff osteotomy, a proximal metatarsal osteotomy for surgical correction of severe metatarsus primus varus with hallux valgus deformity. METHOD: 70 feet in 67 patients from 25 to 78 years (average age 56 years) were included in this prospective study. The patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot metatarsophalangeal interphalangeal score, which was used preoperatively and at an average follow-up of 37 +/- 6 months. Weight-bearing foot radiographs were analysed according to AOFAS guidelines and statistical evaluation was made with the Wilcoxon signed-rank test. RESULTS: The average AOFAS score improved significantly (p < 0.0001) from 55.2 +/- 15.2 points preoperatively to 86.6 +/- 15.2 points at follow-up. Preoperatively, all patients complained of pain (20.2 +/- 9.6 points) which had improved significantly (p < 0.0001) at the latest follow-up (37.3 +/- 5.7 points). The average hallux valgus angle (HVA) was 37 +/- 8 degrees preoperatively and improved significantly to 12 +/- 11 degrees at follow-up (p = 0.0001). The intermetatarsal angle (IMA) improved significantly from 18 +/- 2 degrees preoperatively to 8 degrees +/- 4 degrees after 37 +/- 6 months (p = 0.0002). The sesamoid position improved significantly from preoperative to follow-up (p = 0.0003). Radiographic evaluation of the patients indicated that all examined osteotomies had healed after 37 +/- 6 months. CONCLUSION: This prospective investigation at intermediate follow-up using currently available outcome measures suggests that the Ludloff osteotomy is a suitable procedure for the surgical correction of severe metatarsus primus varus (IMA > 15 degrees ) with hallux valgus deformity.     

Therapie des kindlichen Hallux valgus

Hallux valgus deformities in children and adolescents are attributed to various malformations. Meticulous assessment of clinical and radiological findings as well as age-dependent progress of hallux malalignment has to be taken into consideration to work out an individual therapeutic concept. Conservative treatment includes both night splints and exercises. Surgical therapy has to be strictly based on objective criteria, i.e. the size of the first intermetatarsal angle and correction of the distal metatarsal articular angle. Moderate deformities can be corrected with three-dimensional distal metatarsal osteotomy. Severe hallux valgus deformities often require a double metatarsal osteotomy to address the intermetatarsal angle and the distal metatarsal articular angle. In cases of additional hallux valgus interphalangeus further osteotomy of the proximal phalanx (triple osteotomy) is necessary.     

Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus

Purpose

This study compared results of distal and proximal metatarsal osteotomy for moderate to severe hallux valgus in terms of radiographic correction and functional outcome.

Methods

We analyzed 125 moderate to severe hallux valgus surgeries. Patients were divided into two groups. Group 1 underwent distal metatarsal osteotomy, and group 2 underwent proximal metatarsal osteotomy. Patients were interviewed for functional scores before and one year after surgery. The anteroposterior (AP) weight-bearing radiography of the foot was taken before and one year after surgery.

Results

There were no significant differences in pain and function after one year in either group. Both groups experienced significant pain reduction and increase in all functional scores. There was significant improvement of hallux valgus and intermetatarsal angle corrections in group 2. There was less improvement in radiographic correction in group 1.

Conclusion

Either distal or proximal metatarsal osteotomy is an appropriate pain-relieving procedure and can increase functional outcome in moderate to severe hallux valgus. However, distal metatarsal osteotomy provides lower correction power.     

Clinical results with the Ludloff osteotomy for correction of adult hallux valgus

BACKGROUND: Biomechanically, the Ludloff osteotomy fixed with lag screw compression has been shown to be more rigid than proximal crescentic and other proximal first metatarsal osteotomies for correction of symptomatic hallux valgus with a moderate to severe increase in the first intermetatarsal angle. The Ludloff osteotomy may, therefore, have a lower incidence of dorsal malunion and transfer metatarsalgia than other proximal first metatarsal osteotomies, such as the crescentic or chevron. METHODS: We reviewed the results of 82 consecutive cases of moderate to severe hallux valgus deformities corrected with the Ludloff oblique metaphyseal-diaphyseal osteotomy of the first metatarsal combined with a distal soft-tissue procedure and medial eminence resection. RESULTS: Follow-up was possible in 70 cases (85%) at an average of 30 months (range, 18 to 42 months). Preoperatively, the mean hallux valgus and first intermetatarsal angles were 31 degrees and 16 degrees, respectively. Postoperatively, these values improved to an average of 11 degrees and 7 degrees. In the sagittal plane, the first metatarsal was plantarflexed by an average of 1 mm, and there were no symptomatic transfer lesions of the second metatarsal. The mean AOFAS hindfoot score improved from 54 to 91 points. Complications included prominent hardware requiring removal (5), hallux varus (4), delayed union (3), superficial infection (3), and neuralgia (3). CONCLUSIONS: The use of the Ludloff oblique first metatarsal osteotomy resulted in excellent correction of the first intermetatarsal angle in patients with moderate to severe hallux valgus. With the plane of the osteotomy and rigidity of fixation, immediate ambulation was possible with minimal risk of dorsiflexion malunion of the first metatarsal.     

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。