Lapidus 手术治疗复发性拇外翻。

The use of the Lapidus procedure for recurrent hallux valgus.

机构信息

Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA.

出版信息

Foot Ankle Int. 2011 Jul;32(7):674-80. doi: 10.3113/FAI.2011.0674.

DOI:10.3113/FAI.2011.0674

PMID:21972761

Abstract

BACKGROUND

The objective of this study was to evaluate the Lapidus procedure or it's modifications for treatment of recurrent hallux valgus (HV). Our hypothesis was that the Lapidus procedure would achieve good correction of recurrent HV and patients would be satisfied.

MATERIALS AND METHODS

A retrospective review of 32 feet (30 patients) treated with the Lapidus procedure for recurrent HV with at least 1-year followup was performed. Evaluation included radiographs, examination, and chart review. Outcomes were assessed with a pain visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, SF-12, Revised Foot Function Index (RFFI), and a survey. Twenty-three of 30 patients (25 feet) met the criteria for inclusion in the study and were available for followup evaluation. The average followup was 31.6 months.

RESULTS

Arthrodesis was present in 24 out of 25 feet (96%). The time from initial HV correction to revision surgery was 91 months. The initial surgery performed was a distal osteotomy (15), proximal osteotomy (five), exostectomy (two), diaphyseal osteotomy (two), and proximal/distal osteotomy (one). Preoperative evaluation revealed 96% of patients had clinical hypermobility of the first TMT joint and 52% had radiographic findings of instability. The average postoperative AOFAS hallux score was 82.8, SF-12 score was 94.5, and RFFI was 101. The average preoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were 36.2, 13.6, 18.6 degrees, respectively, which corrected to an average of 15.2, 7.5, 11.7 degrees postoperatively (p < 0.001). The average shortening of the first ray was 2.9 mm. Average pain VAS was 2.4. Eighty-seven percent reported good to excellent results. Using a multivariable linear regression analysis, postoperative HVA along with change in length of the first ray were significant predictors of quality of life based on SF-12 (p < 0.05).

CONCLUSION

The Lapidus procedure corrected recurrent HV with a low nonunion rate and excellent radiographic correction and patients were satisfied with their outcome.

LEVEL OF EVIDENCE

IV, Retrospective Case Series

摘要

背景

本研究的目的是评估 Lapidus 手术或其改良术式治疗复发性拇外翻（HV）的效果。我们的假设是 Lapidus 手术能够实现对复发性 HV 的良好矫正，并且患者会满意。

材料与方法

对接受 Lapidus 手术治疗复发性 HV 并至少随访 1 年的 32 足（30 例）进行回顾性研究。评估包括影像学检查、体格检查和病历回顾。采用疼痛视觉模拟评分（VAS）、美国矫形足踝协会（AOFAS）拇趾评分、SF-12 评分、修订后的足部功能指数（RFFI）和问卷调查评估结果。30 例患者中的 23 例（25 足）符合纳入研究标准并可进行随访评估。平均随访时间为 31.6 个月。

结果

25 足中 24 足（96%）融合。初次 HV 矫正至翻修手术的时间为 91 个月。初次手术为：远端骨切开术（15 足）、近端骨切开术（5 足）、骨切除术（2 足）、骨干骨切开术（2 足）和近端/远端骨切开术（1 足）。术前评估显示，96%的患者第一跖间关节存在临床过度活动，52%的患者存在影像学不稳定表现。术后平均 AOFAS 拇趾评分 82.8，SF-12 评分 94.5，RFFI 评分 101。术前平均拇外翻角（HVA）、跖骨间角（IMA）和远节跖骨关节角（DMAA）分别为 36.2°、13.6°和 18.6°，术后平均矫正至 15.2°、7.5°和 11.7°（p<0.001）。第一跖骨平均缩短 2.9mm。平均疼痛 VAS 为 2.4。87%的患者报告结果良好或优秀。采用多变量线性回归分析，术后 HVA 以及第一跖骨长度变化是 SF-12 评分相关生活质量的显著预测因素（p<0.05）。