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。

Case-control study on Scarf and double metatarsal osteotomy of the first metatarsal for the treatment of hallux valgus deformity

Objective: To compare clinical efficacy of scarf osteotomy and double metatarsal osteotomy(DMO) in treating moderate to severe hallux valgus.Methods: Fifty patients (81 feet) with moderate to severe hallux valgus deformity were treated from January 2017 to December 2019, and were divided into Scarf osteotomy (SO) group or DMO group according to different osteotomy methods. There were 26 patients (44 feet) in SO group, including 1 male and 25 females, aged from 48 to 65 years old with an average of (55.5±4.67) years old;18 patients (30 feet) with moderate and 8 patients (14 feet) with severe. There were 24 patients(37 feet) in DMO group, including 1 male and 23 females, aged from 45 to 62 years old with an average of (52.1±6.8) years old;there were 14 patients (24 feet) with moderate and 10 patients (13 feet) with severe. Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and relative length of the first metatarsal(RLFM) on weight-bearing anteroposterior radiographs before and after operation were compared. American Orthopaedic Foot and Ankle Society (AOFAS) hallux, metatarsal, and interphalangeal joint scores was used for evaluate clinical effects. Weight bearing time and complications were observed.Results: Fivty patients were followed up. The follow-up time in SO group ranged from 12 to 36 months with an average of(20.50±6.22) months and from 16 to 28 months with an avaerge of(19.80±2.44) months in DMO group while there was no significant difference between two groups(P>0.05). All incision healed at stage I, and osteotomy healed at (20.31±3.17) months after operation. One patient occurred hallux adduction deformity, without transferred metatarsalgia;2 patients occurred metastatic metatarsalgia in DMO group. There were no significant difference in HVA, IMA, DMAA, and AOFAS scores between two groups(P>0.05) before and after operation. There was no significant difference in RLFM between two groups(P>0.05), while had significant difference in RLFM between two groups at final follow-up (P<0.05). Partial weight-bearing time and full weight-bearing time in SO group were significantly earlier than those in DMO group (P<0.05).Conclusion: Both of Scarf osteotomy and the first metatarsal biplane osteotomy could effectively treat moderate to severe hallux valgus deformity, with similar imaging and clinical evaluation. However, the relative length of the first metatarsal bone in SO group was longer than that in DMO group after operation, and the time of weight bearing in Scarf osteotomy is earlier than that of double metatarsal osteotomy of the first metatarsal.