Kim Jin Su, Cho Hun Ki, Young Ki Won, Lee Sang Young, Kim Ji Soo, Lee Kyoungtae
Surgery of Foot and Ankle, CM chungmu general hospital, Yeongdeuon-po, Seoul, Republic of Korea.
Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea
Foot Ankle Int. 2016 Nov;37(11):1189-1196. doi: 10.1177/1071100716661826. Epub 2016 Sep 25.
Scarf osteotomy has been used in hallux valgus surgery due to its large fixation surface for screws and low postoperative complications. However, screws may cause skin irritation from their head, which may require an additional surgical procedure to remove.
This study included 115 patients (106 females and 9 males, 115 feet) who underwent hallux valgus correction with a scarf osteotomy using bioabsorbable screws between September 2010 and September 2012. Preoperative and postoperative 1-month and 1-year radiographic measurements, including intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA), and lateral translational distance (LTD), were obtained. American Orthopaedic Foot & Ankle Society (AOFAS) hallux/forefoot scores were used for patient satisfaction.
Preoperative mean values of HVA, IMA, and PPA of 32.8 degrees, 14.6 degrees, and 7.52 degrees, respectively, improved to 10.7 degrees, 6.0 degrees, and 4.6 degrees, respectively at 1-year follow up (P < .05). The difference in LTD between the 1-month and 1-year follow-up was not statistically significant. AOFAS hallux/forefoot score improved from 69.1 to 96.1 at the 1-year follow up (P < .001). Complete screw absorption was not seen radiographically. Sixteen feet had complications reported. One patient complained of skin irritation over a small protrusion of the screw, and another patient had a foreign body reaction. There were 3 patients with neurologic injury from a popliteal block and 3 patients with dorsal cutaneous nerve symptoms. Four feet had metatarsal fracture during surgery.
We found the scarf osteotomy using bioabsorbable screws to have satisfactory clinical and radiographic results with a low complication rate.
Level IV, case series.
由于围巾式截骨术用于拇外翻手术时螺钉固定面大且术后并发症少，因此被应用于拇外翻手术。然而，螺钉头部可能会引起皮肤刺激，这可能需要额外的手术来取出。
本研究纳入了2010年9月至2012年9月期间采用生物可吸收螺钉行围巾式截骨术矫正拇外翻的115例患者（106例女性，9例男性，共115足）。获取术前、术后1个月和1年的影像学测量数据，包括跖间角（IMA）、拇外翻角（HVA）、第1跖骨头关节角（DMAA）、近节趾骨关节角（PPAA）和外侧平移距离（LTD）。采用美国矫形足踝协会（AOFAS）拇趾/前足评分评估患者满意度。
随访1年时，HVA、IMA和PPAA的术前平均值分别为32.8°、14.6°和7.52°，分别改善至10.7°、6.0°和4.6°（P < 0.05）。1个月和1年随访时LTD的差异无统计学意义。随访1年时，AOFAS拇趾/前足评分从69.1提高到96.1（P < 0.001）。影像学检查未发现螺钉完全吸收。报告有16足出现并发症。1例患者抱怨螺钉小突起处有皮肤刺激，另1例患者有异物反应。3例患者因腘窝阻滞出现神经损伤，3例患者有足背皮神经症状。4足在手术中发生跖骨骨折。
我们发现采用生物可吸收螺钉的围巾式截骨术临床和影像学效果满意，并发症发生率低。
IV级，病例系列。
