Viladot Antonio, Sodano Luca, Marcellini Lorenzo, Zamperetti Marco, Hernandez Elsa Sanchez, Perice Ramon Viladot
COT Service, Clinica Tres Torres, Barcelona, Spain.
Operative Unit of Orthopaedics and Traumatology, Aurelia Hospital, Rome, Italy.
Foot (Edinb). 2017 Aug;32:53-58. doi: 10.1016/j.foot.2017.09.001. Epub 2017 Sep 7.
Hallux Rigidus is the most common degenerative joint pathology of the foot. Several procedures are described for the management of this deformity. In this prospective study we compared Youngswick-Austin and distal oblique osteotomy in the treatment of grade II Hallux Rigidus, in terms of clinical outcomes, efficacy and complications.
Forty-six patients (50 feet) with moderate Hallux Rigidus (Regnauld grade II) were recruited and operated between March 2009 and December 2012. Surgical technique was Youngswick-Austin osteotomy (Group A) or distal oblique osteotomy (Group B).
Mean follow-up was 42.7 ±12.2 (range, 24-70) months. Both groups achieved significant improvement of AOFAS score and first metatarsophalangeal joint range of motion (p value <.05). The mean AOFAS score improved from a preoperative score of 44.1 ±11.8 to 89.2 ± 9.4 (24 months) in Group A and from 40.9 ±11.3 to 89.5 ±7.2 (24 months) in Group B. At 24 months, the average improvement of first metatarsophalangeal joint range of motion was 20.9° in Group A and 22.4° in Group B. The postoperative AOFAS score and joint range of motion were comparable in both groups.
For this specific patient population Youngswick-Austin and distal oblique osteotomies provides subjective patient improvement and increases the first metatarsophalangeal joint range of motion. The results of grade II Hallux Rigidus treatment were comparable when using a Youngswick-Austin or distal oblique osteotomy.
Level II, prospective comparative study.
僵硬性拇趾是足部最常见的退行性关节病变。针对这种畸形的治疗有多种手术方法。在这项前瞻性研究中，我们比较了扬斯威克 - 奥斯汀手术和远端斜行截骨术在治疗II级僵硬性拇趾方面的临床疗效、有效性及并发症情况。
招募了46例（50足）中度僵硬性拇趾（勒尼奥尔德II级）患者，于2009年3月至2012年12月期间接受手术。手术技术采用扬斯威克 - 奥斯汀截骨术（A组）或远端斜行截骨术（B组）。
平均随访时间为42.7±12.2（范围24 - 70）个月。两组患者的美国足踝外科协会（AOFAS）评分及第一跖趾关节活动度均有显著改善（p值<.05）。A组患者的AOFAS评分从术前的44.1±11.8分提高到术后24个月时的89.2±9.4分，B组从40.9±11.3分提高到89.5±7.2分。术后24个月时，A组第一跖趾关节活动度平均改善20.9°，B组为22.4°。两组术后的AOFAS评分及关节活动度相当。
对于这一特定患者群体，扬斯威克 - 奥斯汀手术和远端斜行截骨术均能使患者主观症状改善，并增加第一跖趾关节活动度。使用扬斯威克 - 奥斯汀手术或远端斜行截骨术治疗II级僵硬性拇趾的效果相当。
II级，前瞻性对比研究。
