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拇外翻远端V形截骨术中近端跖骨间分离:一个被忽视的发现。

Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding.

作者信息

Akpinar Evren, Buyuk Abdul Fettah, Cetinkaya Engin, Gursu Sarper, Ucpunar Hanifi, Albayrak Akif

机构信息

Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey.

Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey.

出版信息

J Foot Ankle Surg. 2016 May-Jun;55(3):504-8. doi: 10.1053/j.jfas.2016.01.043. Epub 2016 Feb 26.

Abstract

The goal of distal chevron osteotomy for hallux valgus is to restore proper first-toe joint alignment by performing lateral translation of the distal first metatarsal fragment (the metatarsal head). We hypothesized that in some patients this procedure might also result in involuntary medial translation of the proximal first metatarsal fragment, which we called proximal intermetatarsal divergence. The aim of the present study was to compare the pre- and postoperative radiographs of patients with hallux valgus to determine whether we could identify proximal intermetatarsal divergence. We retrospectively compared the pre- and postoperative radiographs of 29 feet in 28 patients treated with distal chevron osteotomy. Two different methods were used to measure the intermetatarsal angles: the anatomic intermetatarsal angle (aIMA) and the mechanical intermetatarsal angle (mIMA). The maximum intermetatarsal distance (MID) was also measured. We defined proximal intermetatarsal divergence as a postoperative increase in the aIMA or MID, coupled with a decrease in the mIMA. For data analysis, we divided the patients into low-angle (mild deformity) and high-angle (severe deformity) groups, according to their preoperative mIMA. The mean ± standard deviation patient age was 41 ± 14 years. In the low-angle group, the mean mIMA decreased (from 10.91° to 7.00°), the mean aIMA increased (from 11.80° to 13.55°), and the mean MID increased (from 17.97 mm to 20.60 mm; p = .001, for all). In the high-angle group, the mean mIMA decreased (from 14.30° to 6.90°; p = .001), the mean aIMA decreased (from 14.77° to 13.54°; p = .06), and the mean MID decreased (from 20.74 mm to 20.37 mm; p = .64). The results of our study suggest that proximal intermetatarsal divergence might occur after distal chevron osteotomy for hallux valgus, primarily in patients with a low preoperative mIMA.

摘要

拇外翻远端V形截骨术的目标是通过对第一跖骨远端碎片(跖骨头)进行侧向移位,来恢复第一跖趾关节的正常对线。我们推测,在一些患者中,该手术可能还会导致第一跖骨近端碎片意外地向内侧移位,我们将其称为近端跖骨间分离。本研究的目的是比较拇外翻患者术前和术后的X线片,以确定我们是否能识别出近端跖骨间分离。我们回顾性比较了28例接受远端V形截骨术治疗的患者的29只脚的术前和术后X线片。采用两种不同的方法测量跖骨间角:解剖学跖骨间角(aIMA)和力学跖骨间角(mIMA)。还测量了最大跖骨间距离(MID)。我们将近端跖骨间分离定义为术后aIMA或MID增加,同时mIMA减小。为了进行数据分析,我们根据患者术前的mIMA将其分为低角度(轻度畸形)组和高角度(重度畸形)组。患者的平均年龄±标准差为41±14岁。在低角度组中,平均mIMA减小(从10.91°降至7.00°),平均aIMA增加(从11.80°增至13.55°),平均MID增加(从17.97mm增至20.60mm;所有p值均为0.001)。在高角度组中,平均mIMA减小(从14.30°降至6.90°;p值为0.001),平均aIMA减小(从14.77°降至13.54°;p值为0.06),平均MID减小(从20.74mm降至20.37mm;p值为0.64)。我们的研究结果表明,拇外翻远端V形截骨术后可能会出现近端跖骨间分离,主要发生在术前mIMA较低的患者中。

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