Oravakangas Rami, Leppilahti Juhana, Laine Vesa, Niinimäki Tuukka
Researcher, Department of Surgery, Oulu University Hospital, Oulu, Finland.
Professor and Head, Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
J Foot Ankle Surg. 2016 May-Jun;55(3):456-60. doi: 10.1053/j.jfas.2016.01.006. Epub 2016 Feb 20.
Hallux valgus is one of the most common foot deformities. Proximal opening wedge osteotomy is used for the treatment of moderate and severe hallux valgus with metatarsus primus varus. However, hypermobility of the first tarsometatarsal joint can compromise the results of the operation, and a paucity of midterm results are available regarding proximal open wedge osteotomy surgery. The aim of the present study was to assess the midterm results of proximal open wedge osteotomy in a consecutive series of patients with severe hallux valgus. Thirty-one consecutive adult patients (35 feet) with severe hallux valgus underwent proximal open wedge osteotomy. Twenty patients (35.5%) and 23 feet (34.3%) were available for the final follow-up examination. The mean follow-up duration was 5.8 (range 4.6 to 7.0) years. The radiologic measurements and American Orthopaedic Foot and Ankle Society hallux-metatarsophalangeal-interphalangeal scores were recorded pre- and postoperatively, and subjective questionnaires were completed and foot scan analyses performed at the end of the follow-up period. The mean hallux valgus angle decreased from 38° to 23°, and the mean intermetatarsal angle correction decreased from 17° to 10°. The mean improvement in the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal score increased from 52 to 84. Two feet (5.7%) required repeat surgery because of recurrent hallux valgus. No nonunions were identified. Proximal open wedge osteotomy provided satisfactory midterm results in the treatment of severe hallux valgus, with a low complication rate. The potential instability of the first tarsometatarsal joint does not seem to jeopardize the midterm results of the operation.
拇外翻是最常见的足部畸形之一。近端开放性楔形截骨术用于治疗伴有第一跖骨内翻的中重度拇外翻。然而，第一跖跗关节的活动度过大可能会影响手术效果，而且关于近端开放性楔形截骨术的中期结果报道较少。本研究的目的是评估一系列连续的重度拇外翻患者接受近端开放性楔形截骨术的中期结果。31例连续的成年重度拇外翻患者（35足）接受了近端开放性楔形截骨术。20例患者（35.5%）和23足（34.3%）接受了最终随访检查。平均随访时间为5.8年（范围4.6至7.0年）。记录术前和术后的影像学测量结果以及美国矫形足踝协会的拇趾-跖趾-趾间关节评分，并在随访期末完成主观问卷调查并进行足部扫描分析。平均拇外翻角度从38°降至23°，平均跖间角矫正从17°降至10°。美国矫形足踝协会拇趾-跖趾-趾间关节评分的平均改善从52分提高到84分。2足（5.7%）因复发性拇外翻需要再次手术。未发现骨不连。近端开放性楔形截骨术在治疗重度拇外翻方面提供了令人满意的中期结果，并发症发生率较低。第一跖跗关节潜在的不稳定性似乎并未危及手术的中期结果。
