Díaz Fernández Rodrigo
1 Universidad Católica de Valencia San Vicente Mártir, Catholic University of Valencia "Saint Vincent Martyr," Valencia, Spain.
2 Hospital de Manises, Valencia, Spain.
Foot Ankle Int. 2017 Feb;38(2):159-166. doi: 10.1177/1071100716670403. Epub 2016 Oct 1.
Percutaneous surgery to correct deformities of the forefoot presents the advantages of using a minimal incision, which involves less soft tissue damage and less risk of wound complications. For severe deformities, percutaneous techniques have not been proven as effective. We propose a technique for the treatment of severe hallux valgus.
In a sample of 52 feet operated on 48 patients, we performed a double percutaneous osteotomy (closure proximal osteotomy and a distal Akin) or triple when a Reverdin-Isham osteotomy was added. We measured preoperatively the American Orthopaedic Foot & Ankle Society (AOFAS) score at the 1-year and 2-year follow-up, as well as the values of hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular ankle (DMAA), and shortening and elevation of the first metatarsal. The presence of metatarsalgia was recorded before and after the surgery.
HVA, IMA, and DMAA improved from 39.3 ± 7.1, 17.0 ± 2.0, and 16 ± 8.7 to 11.2 ± 6.2, 8.4 ± 3.4, and 8.3 ± 6.2, respectively. In 5 cases (10%), there was an elevation of the distal metatarsal bone, but only in 2 cases did a transfer metatarsalgia develop. There were no significant correlations between the amount of shortening and the presence of postoperative metatarsalgia. Scores on the AOFAS scale improved from 47.6 ± 5.6 to 89.7 ± 10.1 points.
The results are comparable to those reported with other more established techniques. Transfer metatarsalgia did not correlate with lifting or shortening of the metatarsal. We indicate the percutaneous technique for IMA above 15 degrees and increased DMAA or congruent joints.
Level IV, retrospective case series.
经皮手术矫正前足畸形具有切口小的优点，软组织损伤少，伤口并发症风险低。对于严重畸形，经皮技术尚未被证明有效。我们提出一种治疗重度拇外翻的技术。
在对48例患者的52只脚进行的样本研究中，我们进行了双经皮截骨术（近端闭合截骨术和远端Akin截骨术），当增加Reverdin-Isham截骨术时则进行三截骨术。术前测量美国矫形足踝协会（AOFAS）评分，并在1年和2年随访时测量拇外翻角（HVA）、跖间角（IMA）、第一跖骨头远端关节角（DMAA）以及第一跖骨的缩短和抬高情况。记录手术前后是否存在跖痛症。
HVA、IMA和DMAA分别从39.3±7.1、17.0±2.0和16±8.7改善至11.2±6.2、8.4±3.4和8.3±6.2。5例（10%）出现第一跖骨头抬高，但仅2例发生转移性跖痛症。缩短量与术后跖痛症的发生之间无显著相关性。AOFAS量表评分从47.6±5.6提高至89.7±10.1分。
结果与其他更成熟技术所报告的结果相当。转移性跖痛症与跖骨抬高或缩短无关。我们指出，对于IMA大于15度、DMAA增大或关节全等的情况，可采用经皮技术。
IV级，回顾性病例系列。
