Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France.
Foot Ankle Int. 2020 Aug;41(8):984-992. doi: 10.1177/1071100720920863. Epub 2020 May 26.
Lateral release (LR) for the treatment of hallux valgus is a routinely performed technique, either by means of open or minimally invasive (MI) surgery. Despite this, there is no available evidence of the efficacy and safety of MI lateral release. Our aim was to study 2 popular techniques for MI LR in cadavers by subsequently dissecting the released anatomical structures.
Twenty-two cadaveric feet were included in the study and allocated into 2 groups, 1 for each procedure: 1 group underwent a MI adductor tendon release (AR), and in the other group, an extensive percutaneous lateral release (EPLR) (adductor tendon, suspensory ligament, phalanx-sesamoid ligament, lateral head of flexor hallucis brevis, and deep transverse metatarsal ligament) was performed. Anatomical dissection was performed to identify neurovascular injuries and to verify the released structures.
Both techniques demonstrated to be effective in reproducing a MI LR. A satisfactory release of the adductor tendon was achieved equally in both techniques ( = .85), being partial in most EPLR cases and full in the majority of AR cases. The EPLR was successful in releasing the intended additional structures ( < .05). One case of inadvertent complete section of the flexor hallucis longus was identified in the percutaneous adductor tendon release group. No cases of dorsolateral nerve injury were seen with either of the techniques.
Percutaneous lateral release was a reliable and accurate technique in this cadaveric model. The MI AR proved to be more effective in fully releasing the adductor tendon while the ER was intended and able to release a number of other structures.
MI LR is a safe procedure that could obviate the need for open surgery to achieve the same surgical goal. It can be associated to either open or MI osteotomies in the correction of hallux valgus.
外侧松解术（LR）是治疗踇外翻的常规手术方法，包括开放性手术和微创（MI）手术。尽管如此，MI 外侧松解术的疗效和安全性尚无确切证据。我们的目的是通过解剖松解的解剖结构来研究 MI 外侧松解的 2 种常用技术。
本研究纳入 22 例尸体足，分为 2 组，每组 11 例：一组行 MI 收肌腱松解术（AR），另一组行广泛经皮外侧松解术（EPLR）（收肌腱、悬吊韧带、跖骨-籽骨韧带、短屈踇趾肌外侧头和深横跖骨韧带）。进行解剖分离以识别神经血管损伤并验证松解的结构。
两种技术均能有效复制 MI LR。两种技术均能很好地松解收肌腱（=.85），EPLR 大部分为部分松解，AR 大部分为完全松解。EPLR 成功松解了预期的其他结构（<.05）。在经皮收肌腱松解组中有 1 例发现屈踇长肌腱意外完全切断。两种技术均未见背外侧神经损伤。
在本尸体模型中，经皮外侧松解术是一种可靠且准确的技术。MI AR 更有效地充分松解收肌腱，而 ER 则旨在并能够松解其他一些结构。
MI LR 是一种安全的手术方法，可以避免开放性手术来达到相同的手术目的。它可以与开放性或 MI 截骨术联合用于矫正踇外翻。
