Tonbul Murat, Baca Emre, Adaş Müjdat, Ozbaydar Mehmet Uğur, Yurdoğlu H Cihangir
Department of Orthopedics and Traumatology, Okmeydani Training and Research Hospital, Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2009;43(6):497-503. doi: 10.3944/AOTT.2009.497.
This study was designed to draw attention to a distal metatarsal osteotomy technique, which has been somewhat overlooked for the treatment of hallux valgus, and to compare the clinical and radiographic results of two different fixation methods.
The study included 16 feet of 13 patients (11 women, 2 men) who were treated with crescentic distal metatarsal osteotomy for mild-to-moderate hallux valgus (<35 degrees ). The patients were randomized to two fixation methods with two cross K-wires (group 1; 7 patients, 8 feet) and a compressive screw (group 2; 6 patients, 8 feet). The results were evaluated using the AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating scale for hallux, and a visual analog scale for pain. Radiographic measurements included the hallux valgus angle (HVA), first/second intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), before and 12 months after surgery.
There were no significant differences between the two groups with regard to pre- and postoperative AOFAS scores and pain scores, which showed significant improvements in both groups at the end of one-year follow-up (p<0.001). The HVA and IMA significantly decreased from 32 degrees to 19 degrees and from 12 degrees to 6 degrees in group 1, and from 30 degrees to 17 degrees and from 12 degrees to 8 degrees in group 2, respectively (p<0.001). A similar improvement was also seen in the DMAA (p<0.001). Postoperative radiographic improvements were similar in both groups. One patient in group 1 underwent revision surgery with the same technique due to recurrence, and one patient in group 2 had delayed union.
Crescentic distal metatarsal osteotomy may be an appropriate technique in the treatment of mild-to-moderate hallux valgus.
本研究旨在引起人们对一种治疗拇外翻时 somewhat 被忽视的远端跖骨截骨技术的关注，并比较两种不同固定方法的临床和影像学结果。
该研究纳入了 13 例患者（11 名女性，2 名男性）的 16 只脚，这些患者接受了新月形远端跖骨截骨术治疗轻度至中度拇外翻（<35 度）。患者被随机分为两种固定方法，两组分别采用两根交叉克氏针（第 1 组；7 例患者，8 只脚）和一枚加压螺钉（第 2 组；6 例患者，8 只脚）。使用美国矫形足踝协会（AOFAS）拇趾临床评分量表和疼痛视觉模拟量表对结果进行评估。影像学测量包括术前和术后 12 个月的拇外翻角（HVA）、第一/第二跖骨间角（IMA）和远端跖骨关节角（DMAA）。
两组在术前和术后 AOFAS 评分及疼痛评分方面无显著差异，在一年随访结束时两组均有显著改善（p<0.001）。第 1 组的 HVA 和 IMA 分别从 32 度显著降至 19 度和从 12 度降至 6 度，第 2 组分别从 30 度降至 17 度和从 12 度降至 8 度（p<0.001）。DMAA 也有类似改善（p<0.001）。两组术后影像学改善相似。第 1 组有 1 例患者因复发采用相同技术进行了翻修手术，第 2 组有 1 例患者出现延迟愈合。
新月形远端跖骨截骨术可能是治疗轻度至中度拇外翻的一种合适技术。
