Trnka H-J, Hofstaetter S G, Hofstaetter J G, Gruber F, Adams S B, Easley M E
Foot and Ankle Center Vienna/Fusszentrum Wien, Vienna, Austria.
J Bone Joint Surg Am. 2008 Mar;90(3):531-9. doi: 10.2106/JBJS.F.00205.
The modified Ludloff proximal first metatarsal osteotomy is indicated for the surgical correction of moderate-to-severe hallux valgus deformity associated with metatarsus primus varus. We report the intermediate-term results of this procedure.
Ninety-nine patients (111 feet) with a mean age of fifty-six years underwent a modified Ludloff proximal first metatarsal osteotomy and a distal soft-tissue procedure at two institutions for the treatment of a moderate-to-severe hallux valgus deformity. The American Orthopaedic Foot and Ankle Society score and weight-bearing radiographs of the foot were assessed preoperatively and after a mean duration of follow-up of thirty-four months. Clinical and radiographic outcome was also compared between younger and older patients, with the arbitrarily chosen age of sixty years dividing the two groups.
The mean American Orthopaedic Foot and Ankle Society score improved significantly (p < 0.0001) from 53 points preoperatively to 88 points at the time of the most recent follow-up. The mean American Orthopaedic Foot and Ankle Society score for patients who were sixty years of age or less was significantly higher than that for patients who were more than sixty years of age (91 compared with 83 points; p = 0.0057). The mean hallux valgus angle decreased significantly from 35 degrees preoperatively to 9 degrees at the time of the most recent follow-up (p < 0.0001), and the mean intermetatarsal angle decreased significantly from 17 degrees to 8 degrees (p < 0.0001). All osteotomy sites united without dorsiflexion malunion but with a mean first metatarsal shortening of 2.2 mm.
To our knowledge, the present report describes the largest cohort of patients undergoing a modified Ludloff osteotomy for the correction of hallux valgus deformity that has been reported in the literature. Our intermediate-term results demonstrate that the procedure achieves significant correction of moderate-to-severe hallux valgus deformity, significant reduction in forefoot pain, and significant improvement in functional outcome. Patients with an age of sixty years or less appear to have a more favorable outcome.
改良Ludloff第一跖骨近端截骨术适用于手术矫正与第一跖骨内翻相关的中重度拇外翻畸形。我们报告了该手术的中期结果。
99例平均年龄56岁的患者（111足）在两家机构接受了改良Ludloff第一跖骨近端截骨术和远端软组织手术，以治疗中重度拇外翻畸形。术前及平均随访34个月后，评估美国矫形足踝协会评分和足部负重X线片。还比较了年轻患者和老年患者的临床及影像学结果，以60岁为界将两组患者任意划分。
美国矫形足踝协会平均评分从术前的53分显著提高（p < 0.0001）至最近一次随访时的88分。60岁及以下患者的美国矫形足踝协会平均评分显著高于60岁以上患者（分别为91分和83分；p = 0.0057）。拇外翻平均角度从术前的35度显著降至最近一次随访时的9度（p < 0.0001），第一跖骨间平均角度从17度显著降至8度（p < 0.0001）。所有截骨部位均愈合，无背屈畸形愈合，但第一跖骨平均缩短2.2 mm。
据我们所知，本报告描述了文献中报道的接受改良Ludloff截骨术矫正拇外翻畸形的最大患者队列。我们的中期结果表明，该手术能显著矫正中重度拇外翻畸形，显著减轻前足疼痛，并显著改善功能结局。60岁及以下患者似乎有更良好的结果。
