青少年拇外翻手术矫正的初步影像学结果：单近端、单远端与双截骨术对比
Preliminary radiographic outcomes of surgical correction in juvenile hallux valgus: single proximal, single distal versus double osteotomies.
作者信息
Edmonds Eric W, Ek Dorsey, Bomar James D, Joffe Avrum, Mubarak Scott J
机构信息
*Department of Orthopedic Surgery, Rady Children's Hospital and Health Center †Department of Orthopedic Surgery, University of California San Diego, San Diego, CA ‡Creighton University School of Medicine, Omaha, NB §North Jersey Pediatric Orthopedics, Ridgewood, NJ.
出版信息
J Pediatr Orthop. 2015 Apr-May;35(3):307-13. doi: 10.1097/BPO.0000000000000257.
BACKGROUND
Surgical correction of juvenile hallux valgus has a high risk of recurrence and complications. This short-term follow-up study evaluates the radiographic differences between 3 osteotomy types: distal first metatarsal osteotomy, proximal first metatarsal osteotomy, and double first metatarsal osteotomy with regard to ability to achieve correction and the risk of hallux varus.
METHODS
A total of 106 feet were evaluated. Percent correction of hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) was recorded, as well as complication and reoperation rates. Radiographs were evaluated at the initial visit, intraoperatively, and at final follow-up.
RESULTS
The single distal osteotomy achieved: IMA within normal limits 21% of the time with no cases of overcorrection; HVA within normal limits 42% of the time with 13% overcorrected; and DMAA within normal limits 46% of the time with 4% overcorrected.The single proximal osteotomy achieved: IMA within normal limits 36% of the time with no cases of overcorrection; HVA within normal limits 36% of the time with no cases of overcorrection; and DMAA within normal limits 36% of the time with 7% overcorrected.The double osteotomy achieved: IMA within normal limits 54% of the time with no cases of overcorrection; HVA within normal limits 40% of the time with 7% overcorrected; and DMAA within normal limits 56% of the time with 22% overcorrected.The rate of HVA overcorrection was not found to be correlated with osteotomy type (P=0.37). The double osteotomy was found to have a higher DMAA overcorrection rate than either single osteotomy (P<0.001).
CONCLUSIONS
The single distal osteotomy for juvenile hallux valgus seems to have the most consistent outcomes, with improved radiographic parameters and low risk of complication compared with the other surgical cohorts. However, the double osteotomy can have the best correction of all 3 radiographic parameters at once, but the highest risk for overcorrection of the DMAA.
LEVEL OF EVIDENCE
Level III-retrospective case control study.
背景
青少年拇外翻的手术矫正具有较高的复发和并发症风险。这项短期随访研究评估了三种截骨术式（第一跖骨远端截骨术、第一跖骨近端截骨术和双第一跖骨截骨术）在实现矫正能力和拇内翻风险方面的影像学差异。
方法
共评估了106只脚。记录拇外翻角（HVA）、跖间角（IMA）和第一跖骨远端关节角（DMAA）的矫正百分比，以及并发症和再次手术率。在初次就诊时、术中及最终随访时对X线片进行评估。
结果
单纯远端截骨术的情况如下：IMA在正常范围内的时间占21%，无过度矫正病例；HVA在正常范围内的时间占42%，13%出现过度矫正；DMAA在正常范围内的时间占46%，4%出现过度矫正。单纯近端截骨术的情况如下：IMA在正常范围内的时间占36%，无过度矫正病例；HVA在正常范围内的时间占36%，无过度矫正病例；DMAA在正常范围内的时间占36%，7%出现过度矫正。双截骨术的情况如下：IMA在正常范围内的时间占54%，无过度矫正病例；HVA在正常范围内的时间占40%，7%出现过度矫正；DMAA在正常范围内的时间占56%，22%出现过度矫正。未发现HVA过度矫正率与截骨术式相关（P=0.37）。发现双截骨术的DMAA过度矫正率高于任何一种单截骨术（P<0.001）。
结论
青少年拇外翻的单纯远端截骨术似乎具有最一致的结果，与其他手术组相比，影像学参数得到改善且并发症风险较低。然而双截骨术可一次性对所有三个影像学参数进行最佳矫正，但DMAA过度矫正风险最高。
证据水平
III级——回顾性病例对照研究。
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