Eulji University, College of Medicine, Seoul, Korea.
Foot Ankle Int. 2013 Aug;34(8):1111-6. doi: 10.1177/1071100713488764. Epub 2013 Apr 26.
Several studies show that hallux valgus has a female preponderance and that approximately 50% of patients have an adolescent onset of deformity. However, little is known about male adolescent-onset hallux valgus. We evaluated the radiologic characteristics and the result of deformity correction in male adolescent-onset hallux valgus (MAHV).
We evaluated 31 feet with MAHV that received corrective osteotomies (16 scarf, 11 distal chevron, 4 proximal chevron, and 21 Akin). The patients' mean age was 22 years. Using standard weight-bearing radiographs, we measured hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), proximal phalangeal angle (PPA), metatarsus adductus angle (MAA), and congruency, preoperatively and at an average of 21 months after surgery. We assessed the clinical outcome at follow-up with regard to patient satisfaction using the American Orthopedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal score.
The mean HVA, IMA, DMAA, and PPA decreased from 28.8, 12.0, 11.9, and 6.5 degrees to 10.9, 4.2, 9.7, and 6.3 degrees, respectively (P < .05). Preoperative congruency was 68% (21 of 31 feet). All feet had metatarsus adductus, and the mean MAA was 26.7 degrees. The mean AOFAS score increased from 64.3 to 92.7. Excellent and good satisfaction rate was 94% (29 of 31 feet). We had 2 complications: 1 patient with acute deep infection and 1 patient with complex regional pain syndrome type II accompanying neuralgia of the hallux.
Most of the patients with MAHV had congruent first metatarsophalangeal joints consistent with increased MAA and DMAA. They also had high PPA and relatively lower IMA. Metatarsal osteotomy with lateral translation and phalangeal corrective osteotomy for MAHV was a reliable technique with successful outcomes and low complication rates.
Level IV, retrospective case series.
多项研究表明，拇外翻存在女性发病倾向，约 50%的患者于青少年时期发病。然而，对于男性青少年发病的拇外翻知之甚少。我们评估了男性青少年发病的拇外翻（MAHV）的放射学特征和畸形矫正效果。
我们评估了 31 例接受矫正性截骨术（16 例 Scarf 截骨术、11 例远端 Chevron 截骨术、4 例近端 Chevron 截骨术和 21 例 Akin 截骨术）的 MAVH 患者的足部。患者平均年龄为 22 岁。我们使用标准负重位 X 线片，在术前和术后平均 21 个月时测量拇外翻角（HVA）、第一跖骨间角（IMA）、远节跖骨关节角（DMAA）、近节趾骨角（PPA）、跖骨内收角（MAA）和关节吻合度，并采用美国矫形足踝协会（AOFAS）的拇趾-跖趾-趾间关节评分评估临床结果。
HVA、IMA、DMAA 和 PPA 均值分别从 28.8°、12.0°、11.9°和 6.5°降低至 10.9°、4.2°、9.7°和 6.3°（P＜0.05）。术前关节吻合度为 68%（31 足中的 21 足）。所有足均存在跖骨内收，MAA 均值为 26.7°。AOFAS 评分从 64.3 分提高至 92.7 分。优和良的满意度为 94%（31 足中的 29 足）。我们有 2 例并发症：1 例患者出现急性深部感染，1 例患者出现 II 型复杂性区域疼痛综合征，伴有拇趾神经痛。
大多数 MAVH 患者的第一跖趾关节吻合，这与增大的 MAA 和 DMAA 一致。他们也有较高的 PPA 和相对较低的 IMA。对于 MAVH，采用外侧平移和趾骨矫正性截骨的跖骨截骨术是一种可靠的技术，具有良好的效果和较低的并发症发生率。
IV 级，回顾性病例系列研究。
