Han Seung Hwan, Park Eui Hyun, Jo Joon, Koh Yong Gon, Lee Jin Woo, Choi Woo Jin, Kim Yong Sang
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Yonsei Altair Hospital, Seoul, Korea.
Yonsei Med J. 2015 May;56(3):744-52. doi: 10.3349/ymj.2015.56.3.744.
The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy.
We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation.
Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 groups (6.1±2.7° in group A and 6.0±2.1° in group B). However, a greater correction in the HVA and distance from the first to the second metatarsal were found in group B (HVA, 13.2±8.2°; distance, 25.1±0.2 mm) compared to group A (HVA, 20.9±7.7°; distance, 28.1±0.3 mm; p<0.001). AOFAS scores were improved in both groups. However, group B demonstrated a greater improvement relative to group A (p=0.005).
Compared with a straight first metatarsal osteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes.
本研究旨在比较采用直形截骨术与斜形截骨术进行第一跖骨近端开放性楔形截骨术的临床和影像学结果。
我们回顾性分析了95例拇外翻畸形患者连续接受的104例第一跖骨近端开放性楔形截骨术。26足采用直形跖骨截骨术治疗（A组），而78足采用斜形跖骨截骨术治疗（B组）。测量拇外翻角（HVA）、跖间角（IMA）、第一跖骨远端关节角以及第一跖骨与第二跖骨间的距离（间距）用于影像学评估，而采用美国矫形足踝协会（AOFAS）前足评分进行临床评估。
两组在末次随访时HVA、IMA以及第一跖骨与第二跖骨间的距离均得到显著矫正（p<0.001）。两组间IMA平均矫正量无差异（A组为6.1±2.7°，B组为6.0±2.1°）。然而，与A组相比，B组在HVA及第一跖骨与第二跖骨间的距离矫正方面更大（HVA：A组为20.9±7.7°，B组为13.2±8.2°；间距：A组为28.1±0.3mm，B组为25.1±0.2mm；p<0.001）。两组的AOFAS评分均有所提高。然而，B组相对于A组改善更大（p=0.005）。
与直形第一跖骨截骨术相比，斜形第一跖骨截骨术可产生更好的临床和影像学结果。
