Schlickewei C, Ridderbusch K, Breyer S, Spiro A, Stücker R, Rupprecht M
Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg Germany.
Department of Pediatric Orthopaedics, Altonaer Children's Hospital, Hamburg, Germany.
J Child Orthop. 2018 Aug 1;12(4):375-382. doi: 10.1302/1863-2548.12.170208.
Juvenile hallux valgus deformity (JHVD) is rare but may be associated with symptoms or deformities that require surgical treatment. Literature recommends waiting to perform surgical treatment until maturity. However, if conservative treatment is not sufficient and the children's psychological or physical suffering is particularly severe, earlier surgical treatment should be considered. The aim of this study was to evaluate the safety and efficiency of temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal as a new treatment option for JHVD during growth age.
Between June 2011 and November 2017, 33 patients (24 girls, nine boys; 59 feet) with a JHVD were treated by temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal. At the time of surgery mean age was 11.1 years SD 1.4 (8 to 15). Patients were followed clinically and with standing, weight-bearing radiographs of the feet in two planes.
In all, 22 patients (39 feet) were included into this study. Mean follow-up was 27.8 months SD 9.9 (12 to 58). The hallux valgus angle changed from 26.5° SD 6.6° preoperatively to 20.2° SD 6.2° (p < 0.001) at time of follow-up. The intermetatarsal angle changed from 14.1° SD 5.4° to 10.5° SD 2.9° during this time (p < 0.01). In two patients (three feet) the screws were removed before the JHVD was fully corrected due to local tenderness over the screw head. In two patients screw migration away from the growth plate was observed, resulting in no further deformity correction in one patient and increasing deformity in the other patient. No other complications were seen.
Temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal seems to be an effective, safe, technically easy and minimally invasive early treatment option to correct JHVD in children with particularly severe suffering. Due to the individual correction rate, frequent follow-up visits are recommended until skeletal maturity.
IV.
青少年拇外翻畸形（JHVD）较为罕见，但可能伴有需要手术治疗的症状或畸形。文献建议等到骨骼成熟后再进行手术治疗。然而，如果保守治疗效果不佳且儿童的心理或身体痛苦特别严重，则应考虑早期手术治疗。本研究的目的是评估第一跖骨外侧骨骺板临时螺钉骨骺阻滞术作为生长发育期JHVD新治疗选择的安全性和有效性。
2011年6月至2017年11月期间，对33例（24例女孩，9例男孩；59足）JHVD患者采用第一跖骨外侧骨骺板临时螺钉骨骺阻滞术进行治疗。手术时平均年龄为11.1岁，标准差1.4（8至15岁）。对患者进行临床随访，并拍摄双平面站立负重足部X线片。
共有22例患者（39足）纳入本研究。平均随访时间为27.8个月，标准差9.9（12至58个月）。随访时，拇外翻角从术前的26.5°±6.6°变为20.2°±6.2°（p<0.001）。在此期间，跖间角从14.1°±5.4°变为10.5°±2.9°（p<0.01）。2例患者（3足）因螺钉头部局部压痛，在JHVD完全矫正前取出螺钉。2例患者观察到螺钉从生长板移位，其中1例患者畸形未进一步矫正，另1例患者畸形加重。未见其他并发症。
第一跖骨外侧骨骺板临时螺钉骨骺阻滞术似乎是一种有效、安全、技术简单且微创的早期治疗选择，可用于矫正痛苦特别严重的儿童的JHVD。由于个体矫正率不同，建议在骨骼成熟前进行频繁随访。
IV级。
