Farrar N G, Duncan N, Ahmed N, Rajan R A
Department of Orthopaedics, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE UK.
J Child Orthop. 2012 Jun;6(2):153-7. doi: 10.1007/s11832-012-0396-0. Epub 2012 Mar 17.
This study was designed to assess the utility of the scarf osteotomy in the management of symptomatic adolescent hallux valgus.
This is a case series of 29 patients (39 feet) with a mean follow up of 38.6 months (range 6-60 months). The mean age at the time of surgery was 14.1 years (range 10-17 years). American Orthopaedic Foot and Ankle Society (AOFAS) scores were collected at final follow up, along with a rating of the overall satisfaction. Any complications were recorded. Pre- and post-surgical radiographic angles were measured and analysed using the Student's t-test. The angles measured were the hallux valgus angle (HVA), the inter-metatarsal angle (IMA) and the distal metatarsal articular angle (DMAA). A second surgeon independently reviewed the angles in order to assess the inter-rater reliability using the Pearson product moment correlation.
The mean AOFAS score at final follow up was 94.2 (range 54-100). Of all patients, 93 % were either satisfied or very satisfied with their final outcome. One patient has been listed for revision surgery after symptomatic recurrence at 3 years follow up. The pre-operative HVA, IMA and DMAA were 34.8°, 15.9° and 16.0°, respectively. The post-operative values were 16.3°, 8.8° and 9.2°, respectively (p < 0.001 for each). Pearson's r coefficient values demonstrated good inter-rater reliability of measurement.
We have presented the results of the largest case series of scarf osteotomies for adolescent hallux valgus reported in the literature up to now, as far as we are aware. AOFAS scores at final follow up are comparable to the smaller studies previously reported and provide evidence that good outcomes and high levels of patient satisfaction can be achieved. Early follow up demonstrates a low level of symptomatic recurrence, but longer term data are still required.
本研究旨在评估围巾截骨术在治疗有症状的青少年拇外翻中的效用。
这是一个包含29例患者（39只脚）的病例系列，平均随访时间为38.6个月（范围6 - 60个月）。手术时的平均年龄为14.1岁（范围10 - 17岁）。在末次随访时收集美国矫形足踝协会（AOFAS）评分以及总体满意度评级。记录所有并发症。使用学生t检验对手术前后的影像学角度进行测量和分析。测量的角度包括拇外翻角（HVA）、跖间角（IMA）和第一跖骨头关节角（DMAA）。另一位外科医生独立复查这些角度，以便使用皮尔逊积矩相关系数评估评分者间的可靠性。
末次随访时AOFAS评分的平均值为94.2（范围54 - 100）。所有患者中，93%对最终结果感到满意或非常满意。1例患者在3年随访出现症状复发后被列入翻修手术名单。术前HVA、IMA和DMAA分别为34.8°、15.9°和16.0°。术后值分别为16.3°、8.8°和9.2°（每个角度p < 0.001）。皮尔逊r系数值表明测量具有良好的评分者间可靠性。
据我们所知，我们展示了目前文献中报道的关于青少年拇外翻的最大规模围巾截骨术病例系列的结果。末次随访时的AOFAS评分与先前报道的较小研究结果相当，并提供了可以实现良好结果和高患者满意度的证据。早期随访显示症状复发率较低，但仍需要长期数据。
