Hofstaetter S G, Gruber F, Ritschl P, Trnka H J
Fusszentrum Wien.
Z Orthop Ihre Grenzgeb. 2006 Mar-Apr;144(2):141-7. doi: 10.1055/s-2005-918193.
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.
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.
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.
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.
本研究探讨改良Ludloff截骨术的临床及影像学中期结果，该手术是一种近端跖骨截骨术，用于手术矫正伴有拇外翻畸形的重度第一跖骨内翻。
本前瞻性研究纳入了67例患者的70只脚，年龄在25至78岁之间（平均年龄56岁）。采用美国矫形足踝协会（AOFAS）前足跖趾关节和趾间关节评分对患者进行评估，该评分在术前及平均随访37±6个月时使用。根据AOFAS指南对负重足部X线片进行分析，并采用Wilcoxon符号秩检验进行统计学评估。
平均AOFAS评分从术前的55.2±15.2分显著提高（p<0.0001）至随访时的86.6±15.2分。术前，所有患者均主诉疼痛（20.2±9.6分），在最近一次随访时疼痛显著改善（p<0.0001）（37.3±5.7分）。术前平均拇外翻角（HVA）为37±8度，随访时显著改善至12±l1度（p=0.0001）。跖间角（IMA）从术前平均18±2度显著改善至37±6个月后的8±4度（p=0.0002）。籽骨位置从术前到随访时显著改善（p=0.0003）。对患者的影像学评估表明，所有接受检查的截骨术在37±6个月后均已愈合。
这项使用现有结果指标进行中期随访的前瞻性研究表明，Ludloff截骨术是一种适用于手术矫正伴有拇外翻畸形的重度第一跖骨内翻（IMA>15度）的手术方法。
