Arbab Dariusch, Schneider Lisa-Maria, Schnurr Christoph, Bouillon Bertil, Eysel Peer, König Dietmar Pierre
Orthopädische Klinik, Klinikum Dortmund gGmbH.
Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf.
Z Orthop Unfall. 2018 Apr;156(2):193-199. doi: 10.1055/s-0043-120352. Epub 2017 Nov 10.
Hallux valgus is one of the most prevalent foot deformities, and surgical treatment of Hallux valgus is one of the most common procedures in foot and ankle surgery. Diagnostic and treatment standards show large variation despite medical guidelines and national foot and ankle societies. The aim of this nationwide survey is a description of the current status of diagnostics and therapy of Hallux valgus in Germany.
A nationwide online questionnaire survey was sent to two German foot and ankle societies. The participants were asked to answer a questionnaire of 53 questions with four subgroups (general, diagnostics, operation, preoperative management). Surgical treatment for three clinical cases demonstrating a mild, moderate and severe Hallux valgus deformity was inquired.
427 foot and ankle surgeons answered the questionnaire. 388 participants were certified foot and ankle surgeons from one or both foot and ankle societies. Medical history (78%), preoperative radiographs (100%) and preoperative radiographic management (78%) are of high or very high importance for surgical decision pathway. Outcome scores are used by less than 20% regularly. Open surgery is still the gold standard, whereas minimally invasive surgery is performed by only 7%.
Our survey showed that diagnostic standards are met regularly. There is a wide variation in the type of procedures used to treat Hallux valgus deformity. TMT I arthrodesis is preferred in severe Hallux valgus, but also used to treat moderate and mild deformities. Minimally invasive surgery is still used by a minority of surgeons. It remains to be seen, to what extent minimally invasive surgery will be performed in the future.
拇外翻是最常见的足部畸形之一，拇外翻的手术治疗是足踝外科最常见的手术之一。尽管有医学指南和国家足踝协会，但诊断和治疗标准仍存在很大差异。这项全国性调查的目的是描述德国拇外翻诊断和治疗的现状。
向两个德国足踝协会发送了一份全国性的在线问卷调查。参与者被要求回答一份包含53个问题的问卷，问卷分为四个子组（一般情况、诊断、手术、术前管理）。询问了针对三例分别表现为轻度、中度和重度拇外翻畸形的临床病例的手术治疗情况。
427名足踝外科医生回答了问卷。388名参与者是来自一个或两个足踝协会的认证足踝外科医生。病史（78%）、术前X光片（100%）和术前影像学管理（78%）在手术决策过程中具有高或非常高的重要性。定期使用结果评分的比例不到20%。开放手术仍然是金标准，而微创手术仅占7%。
我们的调查显示，诊断标准得到了定期满足。用于治疗拇外翻畸形的手术类型存在很大差异。第一跖楔关节融合术在重度拇外翻中更受青睐，但也用于治疗中度和轻度畸形。微创手术仍然只有少数外科医生使用。微创手术在未来的应用程度还有待观察。
