Lucas y Hernandez J, Golanó P, Roshan-Zamir S, Darcel V, Chauveaux D, Laffenêtre O
Bordeaux University Hospital, Centre Médico-chirurgical Universitaire du Pied, place Amélie Raba-Léon, Bordeaux, France.
University of Barcelona, Human and Embriology Unit, Dept of experimental pathology and therapeutics, University of Barcelona, Spain.
Bone Joint J. 2016 Mar;98-B(3):365-73. doi: 10.1302/0301-620X.98B3.35666.
The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy.
A total of 38 patients underwent 45 procedures. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up.
The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly.. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx.
Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. Its main asset is that it maintains an excellent range of movement.
The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy whilst maintaining excellent first MTPJ range of motion.
本研究旨在报告由单一外科医生连续治疗的一系列采用经皮关节外反向L形 Chevron（PERC）截骨术治疗中度拇外翻的患者情况。
共有38例患者接受了45次手术。其中女性35例，男性3例。患者的平均年龄为48岁（17至69岁）。另外，37足进行了经皮Akin截骨术，22足进行了经皮外侧关节囊松解术。临床和放射学评估包括前足类型、活动范围、美国矫形足踝协会（AOFAS）评分、主观评分和放射学参数。平均随访时间为59.1个月（45.9至75.2个月）。无患者失访。
AOFAS评分平均从术前的62.5（30至80）提高到术后的97.1（75至100）。共有37例患者（97%）表示满意。在最后一次随访时，拇外翻角、跖间角和近端关节固定角在统计学上有显著减小。第一跖趾关节的活动范围有显著改善。近端趾骨截骨固定的患者活动范围改善更大。
这种经皮手术方法的初步结果很有前景。该技术可靠且可重复。其主要优点是能保持极佳的活动范围。
PERC截骨术是治疗中度拇外翻的一种有效手术方法，它将经皮手术的优点与Chevron截骨术的多功能性相结合，同时保持第一跖趾关节极佳的活动范围。
