Singapore General Hospital, Singapore.
Foot Ankle Int. 2020 Jun;41(6):705-713. doi: 10.1177/1071100720907387. Epub 2020 Mar 4.
Literature is sparse on whether severity of hallux valgus affects outcomes of surgery. We thus aimed to evaluate the impact of hallux valgus severity on the clinical outcomes of surgery.
83 consecutive scarf osteotomies performed by a single surgeon for symptomatic hallux valgus between 2007 and 2011 were divided into 3 groups (mild, moderate, and severe) based on severity of their preoperative hallux valgus using the hallux valgus and intermetatarsal angles. Outcomes were assessed using the visual analog scale (VAS) for pain, 36-Item Short Form Health Survey physical functioning (SFPF) and mental health (SFMH) subscales, and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores. These were assessed preoperatively and at 6 months and 2 years postoperatively. Patient satisfaction was assessed at 6 months and 2 years postoperatively. Eleven (13.2%), 54 (65.1%), and 18 (21.7%) feet were in the mild, moderate, and severe groups, respectively.
There was no difference in preoperative VAS, SFPF, SFMH and AOFAS scores between the groups except for AOFAS scores for the second toe, which were poorer with increasing hallux valgus. Postoperatively, there was improvement across all outcome scores. VAS and AOFAS showed excellent scores, and patient satisfaction was high across all 3 groups (88.9%, 89.4%, and 86.7%). The severe group had slightly lower SFPF scores at 6 months (mild, 81.1; moderate, 84.0; severe, 74.3; = .031) and 2 years postoperatively (mild, 93.4; moderate, 89.7; severe, 76.4; = .005), and slightly poorer second toe scores for VAS (mild, 0.0; moderate, 0.1; severe, 1.2; = .017) and AOFAS (mild, 94.7; moderate, 93.5; severe, 83.4; = .043) at 2 years postoperatively. All other scores including patient satisfaction showed no between-group differences. Complication and revision rates between the groups were similar.
Surgery for symptomatic hallux valgus lead to excellent outcomes and high patient satisfaction regardless of severity of deformity.
Level III, comparative series.
文献中关于拇外翻严重程度是否影响手术结果的内容很少。因此，我们旨在评估拇外翻严重程度对手术结果的影响。
2007 年至 2011 年间，一位外科医生对 83 例因拇外翻引起症状的患者连续进行了 Scarf 截骨术，根据术前拇外翻的严重程度，即拇外翻角和跖间角，将其分为 3 组（轻度、中度和重度）。使用视觉模拟评分（VAS）评估疼痛，36 项简明健康调查量表（SF-36）生理功能（SFPF）和心理健康（SFMH）子量表以及美国矫形足踝协会（AOFAS）踝后足评分评估结果。这些评分在术前和术后 6 个月及 2 年进行评估。在术后 6 个月和 2 年评估患者满意度。11 只（13.2%）、54 只（65.1%）和 18 只（21.7%）脚分别处于轻度、中度和重度组。
除了拇外翻第二趾的 AOFAS 评分随着拇外翻的加重而变差外，各组之间的术前 VAS、SFPF、SFMH 和 AOFAS 评分无差异。术后所有评分均有改善。VAS 和 AOFAS 评分均为优秀，三组患者满意度均较高（88.9%、89.4%和 86.7%）。重度组在术后 6 个月（轻度：81.1；中度：84.0；重度：74.3； =.031）和 2 年（轻度：93.4；中度：89.7；重度：76.4； =.005）时 SFPF 评分略低，术后 2 年时第二趾 VAS（轻度：0.0；中度：0.1；重度：1.2； =.017）和 AOFAS（轻度：94.7；中度：93.5；重度：83.4； =.043）评分也略差。其他所有评分，包括患者满意度，组间均无差异。组间并发症和翻修率相似。
无论畸形程度如何，手术治疗拇外翻引起的症状均能获得良好的结果和高患者满意度。
III 级，比较系列。
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