Saint-Charles Private Hospital, 25, rue de Flesselles, Lyon, France.
Orthop Traumatol Surg Res. 2013 Jun;99(4):425-31. doi: 10.1016/j.otsr.2013.01.009. Epub 2013 May 3.
Lateral release of the sesamoid ligament complex is one of the key step to the surgical treatment of hallux valgus. Although numerous techniques are available to perform this procedure, there is no accepted consensus on the method of choice. The goal of this study was to evaluate the efficacy of sequential release of lateral soft tissue structures for correction of hallux valgus deformity.
This study included 40 patients, mean age 50.9 years old (±17.4), with 49 hallux valgus deformities from mechanical causes. The first metatarsophalangeal angle (M1P1), the intermetatarsal angle (M1M2) and the position of the sesamoids in relation to mechanical axis of M (according to the Research Committee of the American Orthopedic Foot and Ankle Society) were determined on preoperative X-rays. During the procedure, lateral release was performed in several steps: sectioning the metatarsosesamoid suspensory ligament then sectioning the phalangeal insertional band (PIB) and complete detachment of the adductor on the fibular sesamoid ligament. We measured the changes in the M1P1 and M1M2 angles during this step-by-step release.
The M1P1 angle decreased during each step of release and went from 29.9° to 11.1° (P<0.001). The M1M2 decreased by 1.70° following medial capusolorrhaphy. Simple capsulorrhaphy reduced the hallux valgus deformity by 8.2° (44%). Release of the metatarsosesamoid suspensory ligament resulted in a decrease of 3.9° (or 21% of total release), release of the PIB in a decrease of 5.1° (27%) and complete detachment of the adductor in a decrease of 1.5° (8%). Thirty six percent of the sesamoids were reduced after metatarsosesamoid ligament resection, 56% after PIB release, and 60% after adductor release.
Lateral soft tissue release is ensured in most cases by sectioning the metatarsosesamoid suspensory ligament and the PIB. Release of the adductor from the fibular sesamoid has a limited effect.
Lateral soft tissue release should include sectioning the metatarsosesamoid suspensory ligament and detaching the PIB. This release should be enough to correct the deformity without performing any osteotomy in hallux valgus with M1P1<27° and M1M2<10°, as long as a stable medial plane can be obtained.
Level IV.
籽骨韧带复合体的外侧松解是治疗踇外翻的关键步骤之一。尽管有许多技术可用于进行此操作，但在选择方法方面尚无共识。本研究的目的是评估外侧软组织结构序贯松解治疗踇外翻畸形的疗效。
本研究纳入了 40 名平均年龄为 50.9 岁（±17.4）的患者，他们因机械原因导致 49 例踇外翻畸形。术前 X 线片确定第一跖骨间角（M1P1）、跖骨间角（M1M2）和籽骨相对于 M 的机械轴的位置（根据美国矫形足部和踝关节协会的研究委员会）。在手术过程中，外侧松解分几个步骤进行：切断跖籽骨悬韧带，然后切断趾插入带（PIB）并完全从腓侧籽骨上松解内收肌。我们测量了在逐步松解过程中 M1P1 和 M1M2 角度的变化。
在松解的每一步中，M1P1 角度均降低，从 29.9°降至 11.1°（P<0.001）。内侧囊紧缩术后 M1M2 减少 1.70°。单纯囊紧缩术可使踇外翻畸形减少 8.2°（44%）。切断跖籽骨悬韧带可使畸形减少 3.9°（或总松解的 21%），切断 PIB 可使畸形减少 5.1°（27%），完全松解内收肌可使畸形减少 1.5°（8%）。36%的籽骨在切断跖籽骨悬韧带后复位，56%在切断 PIB 后复位，60%在松解内收肌后复位。
外侧软组织松解通常通过切断跖籽骨悬韧带和 PIB 来实现。从腓侧籽骨上松解内收肌的效果有限。
外侧软组织松解应包括切断跖籽骨悬韧带和切断 PIB。在 M1P1<27°和 M1M2<10°的情况下，只要能获得稳定的内侧平面，就无需进行任何截骨术即可矫正畸形，无需进行任何截骨术。
IV 级。
