1 Department of Orthopedics and Rehabilitation, University Hospital in Krakow, Krakow, Poland.
2 Department of Orthopedics and Physiotherapy, Jagiellonian University Collegium Medicum, Krakow, Poland.
Foot Ankle Int. 2018 Nov;39(11):1320-1327. doi: 10.1177/1071100718786498. Epub 2018 Jul 13.
The main goal of the study was to evaluate the costs, clinical and radiologic results, and complications of hallux valgus surgery using scarf osteotomy, depending on the type of fixation (with or without screws).
We evaluated 169 patients who underwent scarf osteotomy between January 2013 and August 2016. The patients were separated into 3 groups depending on the type of stabilization: A, 2 screws (50 patients); B, modified with 1 screw (55 patients); C, modified without implant (64 patients). We assessed duration of surgery, additional procedures, pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA) on anteroposterior and lateral foot weightbearing radiographs, the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale for the clinical assessment preoperatively and at the 12-month follow-up. We recorded all the complications and compared the costs between the groups.
Both the average HVA (A: from 33.7 to 12.6 degrees, B: 35.0 to 13.2 degrees, C: 34.7 to 12.4 degrees) and IMA (A: from 14.9 to 7.5 degrees, B: 15.2 to 6.9 degrees, C: 15.5 to 7.8 degrees) decreased in all groups without significant intergroup differences. The average AOFAS score improved in all the groups (A: from 40 to 88 points, B: 38 to 89 points, C: 42 to 91 points). A similar complication rate was observed (A: 9%, B: 10%, C: 11%). In group C, we noted a shorter time of surgery, and the procedure was the most cost-effective.
Scarf osteotomy without implant stabilization was faster and cost-effective and gave comparable results. It was technically demanding and required patient compliance.
Level III, retrospective comparative study.
本研究的主要目的是评估基于固定方式（有或无螺钉）的拇外翻手术的成本、临床和影像学结果以及并发症，其中固定方式为跖骨骨切开术。
我们评估了 2013 年 1 月至 2016 年 8 月期间接受跖骨骨切开术的 169 名患者。根据稳定方式将患者分为 3 组：A 组（50 例），使用 2 枚螺钉；B 组（55 例），改良使用 1 枚螺钉；C 组（64 例），改良无植入物。我们评估了手术时间、附加手术、术前和术后足正位和负重侧位 X 线片的拇外翻角（HVA）和跖骨间角（IMA）、美国矫形足踝协会（AOFAS）拇趾-跖趾-趾间关节量表的临床评估结果，包括术前和 12 个月随访时的结果。我们记录了所有并发症，并比较了各组之间的成本。
各组的平均 HVA（A 组：从 33.7 度降至 12.6 度，B 组：从 35.0 度降至 13.2 度，C 组：从 34.7 度降至 12.4 度）和 IMA（A 组：从 14.9 度降至 7.5 度，B 组：从 15.2 度降至 6.9 度，C 组：从 15.5 度降至 7.8 度）均有所降低，且组间无显著差异。所有组的 AOFAS 评分均有改善（A 组：从 40 分提高至 88 分，B 组：从 38 分提高至 89 分，C 组：从 42 分提高至 91 分）。各组的并发症发生率相似（A 组：9%，B 组：10%，C 组：11%）。在 C 组中，我们观察到手术时间更短，且该组的成本效益最高。
跖骨骨切开术无植入物稳定是更快和具有成本效益的方法，并且可以获得相似的结果。该方法技术要求较高，需要患者配合。
III 级，回顾性比较研究。
