Deenik A R, Pilot P, Brandt S E, van Mameren H, Geesink R G T, Draijer W F
Bronovo Hospital, Bronovolaan 5 2597 AX, The Hague.
Foot Ankle Int. 2007 May;28(5):537-41. doi: 10.3113/FAI.2007.0537.
The degree of correction of hallux valgus deformity using a distal chevron osteotomy is reported as limited. The scarf osteotomy is reported to correct large intermetatarsal angles (IMA). The purpose of this study was to evaluate if one technique gave greater correction of the IMA and hallux valgus angle (HVA) than the other.
After informed consent, 96 feet in 83 patients were randomized into two treatment groups (49 scarf and 47 chevron osteotomies). The results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Valgus Scale and radiographic HVA and IMA measurements.
At 27 (range 23-31) months followup both groups improved. The AOFAS score in the chevron group improved from 48 to 89 points and in the scarf group from 47 to 91 points. In the chevron group the HVA corrected from 30 to 17 degrees, and in the scarf group the HVA corrected from 29 to 18 degrees. In both groups, the IMA was corrected from 13 to 10 degrees. The differences were not statistically significant. Three patients in the chevron group developed a partial metatarsal head necrosis. In the scarf group, four patients developed grade 1 complex regional pain syndrome compared to one patient in the chevron group.
No differences of statistical significance could be measured between the two groups with respect to the AOFAS score, HVA, and IMA. Although both groups showed good to excellent results, we favor the chevron osteotomy because the procedure is technically less demanding.
据报道，采用远端V形截骨术矫正拇外翻畸形的程度有限。据报道，斜行截骨术可矫正较大的跖间角（IMA）。本研究的目的是评估一种技术是否比另一种技术能更好地矫正IMA和拇外翻角（HVA）。
在获得知情同意后，将83例患者的96只足随机分为两个治疗组（49例行斜行截骨术，47例行V形截骨术）。采用美国矫形足踝协会（AOFAS）拇外翻量表以及影像学测量HVA和IMA来评估结果。
在27个月（范围23 - 31个月）的随访中，两组情况均有改善。V形截骨术组的AOFAS评分从48分提高到89分，斜行截骨术组从47分提高到91分。在V形截骨术组，HVA从30度矫正至17度，在斜行截骨术组，HVA从29度矫正至18度。两组的IMA均从13度矫正至10度。差异无统计学意义。V形截骨术组有3例患者发生部分跖骨头坏死。在斜行截骨术组，4例患者发生1级复杂性区域疼痛综合征，而V形截骨术组为1例。
在AOFAS评分、HVA和IMA方面，两组之间未发现有统计学意义的差异。尽管两组均显示出良好至优异的结果，但我们更倾向于V形截骨术，因为该手术在技术上要求较低。
