Ferrari J, Higgins J P, Williams R L
Department of Podiatry, University College London, 33 Fitzroy Square, London, UK, W1P 6AY.
Cochrane Database Syst Rev. 2000(2):CD000964. doi: 10.1002/14651858.CD000964.
Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot.
To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus.
Medline (1966-October 1998), Embase (1980-1998), Cinahl (1982-1998), Amed (1993-1998), the Cochrane Controlled Trials Register, the Cochrane Musculoskeletal Injuries Trials Register and bibliographies of identified trials were searched. Hand searching of podiatry journals was undertaken. Date of the most recent search: October 1998.
Randomised or quasi-randomised trials of both conservative and surgical treatments of hallux valgus. Excluded were studies comparing areas of surgery not specific to the control of the deformity such as use of anaesthetics or tourniquet placement.
Methodological quality of trials which met the inclusion criteria was independently assessed by two reviewers. Data extraction was undertaken by one reviewer and confirmed by another. The trials were grouped according to the interventions being compared, but the dissimilarity in the comparisons prevented pooling of results.
The methodological quality of the 12 included trials was poor and trial sizes were small. Two trials involving 150 patients evaluated conservative treatments. There was no difference in outcomes between treatment and no treatment. Two trials involving 133 patients compared Keller's arthroplasty with other surgical techniques. In general, there was no advantage in using Keller's over the other techniques, particularly in terms of range of motion and intermetatarsal angle. Three trials involving 205 patients compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Three trials involving 157 patients compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations. Two trials involving 95 patients evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery; early weightbearing was not found to be detrimental to final outcome.
REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to determine which methods of either conservative, operative or post-operative treatment are the most appropriate for the hallux valgus. It is notable that the numbers of patients remaining dissatisfied at follow-up were consistently high (25 to 33%), even when the hallux valgus angle and pain had improved. Assessment of future research should focus on evaluating basic intervention types in eligible patients with similar degrees of deformity. Future research should include patient-focused outcomes, standardised assessment criteria and longer surveillance periods.
拇外翻被归类为大脚趾（拇趾）向足部中线的异常偏斜。
识别和评估用于矫正拇外翻的干预措施的随机试验证据。
检索了医学索引数据库（1966年 - 1998年10月）、荷兰医学文摘数据库（1980年 - 1998年）、护理学与健康领域数据库（1982年 - 1998年）、澳大利亚医学数据库（1993年 - 1998年）、考克兰对照试验注册库、考克兰肌肉骨骼损伤试验注册库以及已识别试验的参考文献目录。对手册式检索足病学杂志。最近一次检索日期：1998年10月。
拇外翻保守治疗和手术治疗的随机或半随机试验。排除比较手术区域而非特定畸形控制区域的研究，如麻醉剂的使用或止血带的放置。
两名评审员独立评估符合纳入标准的试验的方法学质量。由一名评审员进行数据提取，并由另一名评审员确认。试验根据所比较的干预措施进行分组，但比较的差异妨碍了结果的合并。
纳入的12项试验的方法学质量较差，试验规模较小。两项涉及150名患者的试验评估了保守治疗。治疗组与未治疗组在结果上没有差异。两项涉及133名患者的试验比较了凯勒关节成形术与其他手术技术。总体而言，使用凯勒手术并不比其他技术有优势，特别是在活动范围和跖间角方面。三项涉及205名患者的试验比较了V形截骨术（和V形截骨术式）与其他技术。在这些试验中，V形截骨术没有优势。对于某些结果，其他技术效果更好。三项涉及157名患者的试验比较了原始手术与外科医生改良手术的结果。未发现任何改良手术有优势。两项涉及95名患者的试验评估了术后康复方法。持续被动运动的使用似乎能改善手术后的活动范围并加快恢复；未发现早期负重对最终结果有不利影响。
随机试验中没有足够的证据来确定哪种保守、手术或术后治疗方法最适合拇外翻。值得注意的是，即使拇外翻角度和疼痛有所改善，随访中仍有较高比例（25%至33%）的患者不满意。未来研究的评估应集中在评估具有相似畸形程度的合格患者的基本干预类型。未来的研究应包括以患者为中心的结果、标准化评估标准和更长的监测期。
