Saragas Nikiforos P
Linksfield Park Clinic & University of the Witwatersrand, Orthopaedic Surgery, P.O. Box 1153, Highlands North, Johannesburg, Gauteng 2037, South Africa.
Foot Ankle Int. 2009 Oct;30(10):976-80. doi: 10.3113/FAI.2009.0976.
This retrospective study was conducted to evaluate the results of the proximal (basal) opening-wedge osteotomy of the first metatarsal for correction of symptomatic hallux valgus deformity, using a low profile plate.
The procedure was performed by a single surgeon over an 18-month period. Forty-six patients (64 feet) were treated for symptomatic hallux valgus with an average follow up of 20 months. A proximal opening-wedge osteotomy of the first metatarsal and fixation with a low profile plate in combination with a distal soft tissue release with the same postoperative protocol was used in all the patients. Improvement in the hallux valgus angle (HV) and I---II intermetatarsal angle (IM I---II) as well as the AOFAS forefoot score pre and postoperatively (obtained retrospectively from the medical records), were recorded; in particular, the length of the first metatarsal was noted pre- and postoperatively.
The HV and IM I---II angles improved by a mean of 14.7 degrees and 6.4 degrees, respectively. The AOFAS forefoot score improved from a mean of 51.3 to 86.8. The mean increase in the length of the first metatarsal was 2.3 mm. Of the more significant complications, five patients developed a hallux varus (early in the series), one of which was symptomatic, and there was one non-union requiring bone graft.
The proximal opening wedge osteotomy of the first metatarsal in combination with a distal soft tissue release and stable fixation of the low profile plate was an effective method for correcting a moderate hallux valgus deformity. Guidance provided by the "First Metatarsal Opening Wedge Angle Reference Chart'' was found to be helpful for the IM I-II angle correction.
本回顾性研究旨在评估采用低轮廓钢板进行第一跖骨近端（基底）开放楔形截骨术矫正有症状的拇外翻畸形的效果。
该手术由一位外科医生在18个月的时间内完成。46例患者（64足）接受了有症状拇外翻的治疗，平均随访20个月。所有患者均采用第一跖骨近端开放楔形截骨术并用低轮廓钢板固定，同时进行远端软组织松解，术后方案相同。记录术前和术后拇外翻角（HV）和第一、二跖骨间角（IM I-II）的改善情况以及美国足踝外科协会（AOFAS）前足评分（从病历中回顾性获取）；特别记录了术前和术后第一跖骨的长度。
HV和IM I-II角平均分别改善了14.7度和6.4度。AOFAS前足评分从平均51.3分提高到86.8分。第一跖骨长度平均增加2.3毫米。在较严重的并发症中，5例患者出现拇内翻（在该系列早期），其中1例有症状，有1例骨不连需要植骨。
第一跖骨近端开放楔形截骨术联合远端软组织松解及低轮廓钢板的稳定固定是矫正中度拇外翻畸形有效的方法。发现“第一跖骨开放楔形角度参考图表”提供的指导有助于IM I-II角的矫正。
