King Christy M, Hamilton Graham A, Ford Lawrence A
Attending Surgeon, Kaiser San Francisco Bay Area Foot and Ankle Residency, Kaiser Foundation Hospital, Oakland, CA.
Attending Surgeon, Kaiser San Francisco Bay Area Foot and Ankle Residency, Kaiser Foundation Hospital, Antioch, CA.
J Foot Ankle Surg. 2014 Jul-Aug;53(4):415-9. doi: 10.1053/j.jfas.2013.08.007.
Hallux valgus with or without first ray insufficiency has been strongly implicated as a contributing factor in lesser metatarsal overload. The principle goals of a bunionectomy are to relieve the pain, correct the deformity, and restore first metatarsophalangeal joint congruity. Until now, little evidence has been available to assess the effects of bunionectomy procedures on forefoot pressure. The primary aim of the present prospective study was to evaluate the preoperative and postoperative plantar pressures after 2 specific bunionectomies: the chevron bunionectomy and Lapidus arthrodesis. A total of 68 subjects, 34 in each group, were included for radiographic and pedographic evaluation. Both procedures demonstrated radiographic improvements in the mean intermetatarsal and hallux abductus angles. The mean hallux plantar pressure decreased significantly in both procedure groups (p < .001). However, Lapidus group exhibited an increase in the mean fifth metatarsal head plantar pressure (p = .008) and pressure under the fifth metatarsal as a percentage of the total forefoot pressure (p = .01). Furthermore, the pressure under the second metatarsal as a percentage of the total forefoot pressure decreased significantly (p = .01). This study suggests that the Lapidus arthrodesis and chevron bunionectomy both provide correction for hallux valgus deformity, but when comparing forefoot load sharing pressures, the Lapidus arthrodesis appeared to have greater influence on the load sharing distribution of forefoot pressure than did the bunionectomy employing the chevron osteotomy.
伴有或不伴有第一跖骨功能不全的拇外翻已被强烈认为是导致小趾跖骨负荷过重的一个因素。拇囊炎切除术的主要目标是缓解疼痛、矫正畸形以及恢复第一跖趾关节的一致性。到目前为止，几乎没有证据可用于评估拇囊炎切除手术对前足压力的影响。本前瞻性研究的主要目的是评估两种特定拇囊炎切除术后的术前和术后足底压力：V形截骨拇囊炎切除术和Lapidus关节融合术。总共纳入了68名受试者，每组34名，进行影像学和足压测量评估。两种手术在平均跖骨间角和拇外翻角方面均显示出影像学改善。两个手术组的平均拇趾足底压力均显著降低（p < 0.001）。然而，Lapidus组的平均第五跖骨头足底压力增加（p = 0.008），且第五跖骨下压力占前足总压力的百分比增加（p = 0.01）。此外，第二跖骨下压力占前足总压力的百分比显著降低（p = 0.01）。本研究表明，Lapidus关节融合术和V形截骨拇囊炎切除术均能矫正拇外翻畸形，但在比较前足负荷分担压力时，Lapidus关节融合术似乎比采用V形截骨的拇囊炎切除术对前足压力的负荷分担分布影响更大。
