Hopital de Saint Louis-Hospital de Curry Cabral, Orthopaedic Surgery, Rua da Beneficência 8, Lisboa 1500-461 Lisboa, Portugal.
Foot Ankle Int. 2009 Dec;30(12):1149-53. doi: 10.3113/FAI.2009.1149.
The surgical treatment of hallux valgus with an increased distal metatarsal articular angle (DMAA) should include the correction of this angle to maintain a congruent joint. The purpose of this study was to report our results with this procedure.
From January 2000 until December 2006, 23 feet (13 patients) with an increased DMAA were operated upon by the same surgeon using a biplanar chevron osteotomy. The technique was modified making the plantar cut more horizontal and only removing a wedge from the dorsal cut. Clinical and radiographic evaluation was made after a mean followup of 56 months. The AOFAS score for the hallux was used and angular deformities were measured. The patients had a mean age of 51 years and were all female.
A good functional result was achieved with a mean AOFAS score of 87. An improvement of the angular deformities was noted in all patients. The mean hallux valgus angle improved from 28 degrees pre-op to 14 degrees post-op, the intermetatarsal angle from 12 degrees to 7 degrees and the DMAA from 20 degrees to 7 degrees. All patients except one were satisfied with the outcome of the procedure. Minimally symptomatic AVN of the metatarsal head was observed in one foot.
We conclude that this procedure is a good choice for the treatment of symptomatic hallux valgus with an increased DMAA, producing a good clinical and radiographic result.
对于远端跖骨关节角（DMAA）增大的拇外翻，手术治疗应包括纠正该角度以维持关节的一致性。本研究的目的是报告我们采用这种方法的结果。
自 2000 年 1 月至 2006 年 12 月，同一位外科医生对 23 只足（13 名患者）采用双平面楔形截骨术治疗 DMAA 增大的拇外翻。该技术进行了改良，使得足底切口更水平，仅从背侧切口切除楔形。平均随访 56 个月后进行临床和放射学评估。采用 AOFAS 拇趾评分评估，测量角度畸形。患者平均年龄 51 岁，均为女性。
所有患者均获得良好的功能结果，AOFAS 评分平均为 87 分。所有患者的角度畸形均得到改善。拇外翻角从术前的 28 度改善至术后的 14 度，跖骨间角从 12 度改善至 7 度，DMAA 从 20 度改善至 7 度。除 1 例患者外，所有患者均对手术结果满意。1 只足观察到跖骨头有症状性 AVN。
我们认为，对于有症状的 DMAA 增大的拇外翻，该手术是一种较好的治疗方法，可获得良好的临床和放射学结果。
