Vopat Bryan G, Lareau Craig R, Johnson Julie, Reinert Steven E, DiGiovanni Christopher W
Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island (BGV, CRL, CWD).
Foot Ankle Spec. 2013 Dec;6(6):409-16. doi: 10.1177/1938640013508431. Epub 2013 Oct 23.
Scarf and chevron osteotomies are two described treatments for the correction of hallux valgus deformity, but they have traditionally been employed for different levels of severity. We hypothesized that there would be no statistically significant difference between the results of these two treatments.
This study is a retrospective review of 70 consecutive patients treated operatively for moderate and severe hallux valgus malalignment. The two groups based on their operative treatment: scarf osteotomy (Group A) and extended chevron osteotomy (Group B). Preoperative and postoperative hallux valgus angle (HVA), intermetatarsal angle and distal metatarsal articular angle (DMAA) were measured at final follow-up. Charts were also assessed to determine the postoperative rate of satisfaction, stiffness, and pain.
There were no statistically significant differences between Groups A and B with regard to the HVA preoperatively and postoperatively. The DMAA was statistically significantly higher for Group B both preoperatively (p=0.0403) and postoperatively (p<0.0001). The differences in HVA correction and IMA correction were not statistically significant. There were no statistically significant differences with regard to post-operative stiffness, pain, and satisfaction.
The scarf and extended chevron osteotomies are capable of adequately reducing the HVA and IMA in patients with moderate to severe hallux valgus. These two techniques yielded similar patient outcomes in terms of stiffness, pain and satisfaction. Based on these results, we recommend both the scarf and extended chevron osteotomy as acceptable forms of correction for moderate to severe hallux valgus.
围巾式截骨术和人字形截骨术是两种用于矫正拇外翻畸形的治疗方法，但传统上它们用于不同严重程度的病例。我们假设这两种治疗结果之间不存在统计学上的显著差异。
本研究是对70例连续接受手术治疗的中重度拇外翻畸形患者的回顾性分析。根据手术治疗方法将患者分为两组：围巾式截骨术组（A组）和延长人字形截骨术组（B组）。在末次随访时测量术前和术后的拇外翻角（HVA）、跖间角和第一跖骨头远端关节角（DMAA）。还评估病历以确定术后的满意度、僵硬程度和疼痛情况。
A组和B组术前和术后的HVA在统计学上无显著差异。B组术前（p = 0.0403）和术后（p < 0.0001）的DMAA在统计学上显著更高。HVA矫正和跖间角（IMA）矫正的差异无统计学意义。术后僵硬程度、疼痛和满意度方面无统计学显著差异。
围巾式截骨术和延长人字形截骨术能够充分降低中重度拇外翻患者的HVA和IMA。这两种技术在僵硬程度、疼痛和满意度方面产生了相似的患者结果。基于这些结果，我们推荐围巾式截骨术和延长人字形截骨术作为中重度拇外翻可接受的矫正方式。
