Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite, France.
Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite, France; Laboratoire de biomécanique et mécanique des chocs, université Lyon 1, Ifsttar, Lbmc UMR T9406, 69675 Bron, France.
Orthop Traumatol Surg Res. 2018 Sep;104(5):725-731. doi: 10.1016/j.otsr.2018.04.023. Epub 2018 Jun 19.
The Scarf osteotomy is a commonly used surgical procedure for treating hallux valgus in Europe. Screw fixation is standard practice, although some surgeons now go without internal fixation. Plate fixation is still being studied. The aim of this study was to compare the radiological outcomes of these fixation methods, which has not been performed up to now.
Relative to screw fixation, plate fixation of a Scarf osteotomy of the first metatarsal (M1) prevents secondary impaction, without increasing the complication rate or recurrence rate.
A retrospective study was performed of two internal fixation methods for Scarf osteotomy (screw vs. plate), by analyzing the secondary impaction of the first metatarsal, recurrence of the hallux valgus (angle M1P1>20) on X-rays, incidence of complications and potential discomfort related to the hardware. The osteotomy procedure was the same in both groups: 50patients were included consecutively in each fixation group between February 2014 and November 2015.
The mean follow-up was 13.0±2.7months in the screw group and 12.3±1.1 months in the plate group. There were no severe complications, although four cases of delayed wound healing occurred (3in plate group, 1in screw group). In the screw group, there was one case of secondary impaction, two cases of recurrence (4%) and one case of discomfort. In the plate group, there were no cases of impaction, three recurrences (6%) and five cases of discomfort, leading to plate removal in three of these cases.
There was no significant difference between groups in the M1 secondary impaction rate or recurrence rate: screw fixation did not lead to a higher recurrence rate. Systematic fixation with a locked plate for Scarf osteotomy had no advantages over screw fixation in our study.
II, Comparative study with continuous cohorts.
在欧洲，Scarf 截骨术是治疗拇外翻的常用手术方法。螺钉固定是标准做法，尽管现在有些外科医生不再使用内固定。钢板固定仍在研究中。本研究旨在比较这两种固定方法的影像学结果，迄今为止尚未进行过此类比较。
与螺钉固定相比，第一跖骨（M1）Scarf 截骨术的钢板固定可防止二次嵌顿，而不会增加并发症发生率或复发率。
对两种 Scarf 截骨术内固定方法（螺钉与钢板）进行回顾性研究，通过分析第一跖骨的二次嵌顿、拇外翻的复发（M1P1 角>20）、并发症的发生率以及与内固定相关的潜在不适，来比较两种固定方法。两组的截骨术式相同：2014 年 2 月至 2015 年 11 月，连续纳入两组各 50 例患者。
螺钉组的平均随访时间为 13.0±2.7 个月，钢板组为 12.3±1.1 个月。两组均无严重并发症，但螺钉组有 4 例（3 例钢板组，1 例螺钉组）出现延迟愈合。螺钉组有 1 例二次嵌顿，2 例复发（4%），1 例不适。钢板组无嵌顿，3 例复发（6%），5 例不适，其中 3 例需取出钢板。
两组间 M1 二次嵌顿率或复发率无显著差异：螺钉固定不会导致更高的复发率。在我们的研究中，对于 Scarf 截骨术，采用锁定钢板进行系统固定与螺钉固定相比没有优势。
II，连续队列比较研究。
