Jeuken Ralph M, Schotanus Martijn G M, Kort Nanne P, Deenik Axel, Jong Bob, Hendrickx Roel P M
Department of Orthopedic Surgery Zuyderland Hospital, Heerlen-Sittard, the Netherlands Laboratory for Experimental Orthopedics, MUMC+, Maastricht, the Netherlands
Department of Orthopedic Surgery Zuyderland Hospital, Heerlen-Sittard, the Netherlands.
Foot Ankle Int. 2016 Jul;37(7):687-95. doi: 10.1177/1071100716639574. Epub 2016 Mar 23.
Hallux valgus is one of the most common foot deformities. This long-term follow-up study compared the results of 2 widely used operative treatments for hallux valgus: the scarf and chevron osteotomy.
Conventional weight bearing anteroposterior (AP) radiographs of the foot were made for evaluating the intermetatarsal angle and hallux valgus angle. For clinical evaluation, the American Orthopaedic Foot & Ankle Society (AOFAS) rating system for the hallux metatarsophalangeal-interphalangeal scale was used together with physical examination of the foot. These data were compared with the results from the original study. The Short Form 36 questionnaire, the Manchester-Oxford Foot Questionnaire (MOXFQ), and a general questionnaire including a visual analog scale (VAS) pain score were used for subjective evaluation. The primary outcome measures were the radiologic recurrence of hallux valgus and reoperation rate of the same toe. Secondary outcome measures were the results from the radiographs and subjective and clinical evaluation. The response rate was 76% at the follow-up of 14 years; in the chevron group, 37 feet were included compared with 36 feet in the scarf group.
Twenty-eight feet in the chevron group and 27 in the scarf group developed recurrence of hallux valgus (P = .483). One patient in the scarf group had a reoperation of the same toe compared with none in the chevron group (P = .314). Current VAS pain scores and results from the SF-36, MOXFQ, and AOFAS did not significantly differ between groups.
Both techniques showed similar results after 2 years of follow-up. At 14 years of follow-up, neither technique was superior in preventing recurrence.
Level II, randomized controlled trial.
拇外翻是最常见的足部畸形之一。这项长期随访研究比较了两种广泛应用于拇外翻的手术治疗方法的效果：Scarf截骨术和V形截骨术。
拍摄足部常规负重前后位（AP）X线片以评估跖间角和拇外翻角。临床评估方面，采用美国矫形足踝协会（AOFAS）拇趾跖趾关节-趾间关节量表评分系统，并结合足部体格检查。将这些数据与原始研究结果进行比较。采用简明健康状况调查问卷（Short Form 36）、曼彻斯特-牛津足部问卷（MOXFQ）以及包括视觉模拟量表（VAS）疼痛评分的一般问卷进行主观评估。主要观察指标为拇外翻的影像学复发情况和同一趾的再次手术率。次要观察指标为X线片结果以及主观和临床评估结果。随访14年时的应答率为76%；V形截骨术组纳入37足，Scarf截骨术组纳入36足。
V形截骨术组28足和Scarf截骨术组27足出现拇外翻复发（P = 0.483）。Scarf截骨术组有1例患者同一趾进行了再次手术，而V形截骨术组无再次手术病例（P = 0.314）。两组间当前的VAS疼痛评分以及简明健康状况调查问卷、曼彻斯特-牛津足部问卷和美国矫形足踝协会评分结果无显著差异。
两种技术在随访2年后显示出相似的结果。随访14年时，两种技术在预防复发方面均无优势。
II级，随机对照试验。
