Trauma Centre, Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Clinical Pharmacy, Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Orthop Surg. 2020 Dec;12(6):1826-1834. doi: 10.1111/os.12806. Epub 2020 Oct 19.
To present a novel method called triplanar chevron osteotomy to treat hallux valgus (HV).
This is a retrospective study. In this study, the CT data of HV patients with painful callosities were evaluated retrospectively between 1 June 2018 and 1 June 2020. CT data from 49 consecutive patients (59 feet) with HV were evaluated. The average age at the time of surgery was 49.6 years (range, 30-63 years). The apex of the chevron osteotomy procedure was located at the center of the first metatarsal and was defined as the line formed by the central point perpendicular to the fourth metatarsal bone. The cut planes of the plantarward oblique chevron osteotomy (POCO) were defined as follows: chevron osteotomy along with 20° of plantarward obliquity. The triplanar osteotomy incision was made using the POCO method, with the direction inclined by 10° distally. The intermetatarsal angle (IMA), the HV angle (HVA), the projection of the second metatarsal (PSM), the metatarsal protrusion index (MPI), and the metatarsal protrusion distance (MPD) were all calculated before and after the operations. The length of the first metatarsal was measured and calculated with an equation.
The results showed that the HVA was significantly decreased after surgery (32.7° ± 4.6° vs 14.9° ± 2.1°, t = 25.583, P < 0.001) in the triplanar, traditional, and POCO groups. The IMA was also significantly decreased (14.7° ± 2.0°) compared with the results before surgery (8.0° ± 1.1°, t = 22.739, P < 0.001) in these groups. Compared with traditional osteotomy and POCO, there were no differences in correcting deformities on axial planes for the HVA (14.5° ± 1.7° vs 14.9° ± 2.1°, t = 1.835, P = 0.072) and IMA (8.1° ± 1.1° vs 8.0° ± 1.1°, t = -0.97, P = 0.336). There was a statistically significant decrease following surgery in terms of the PSM, MPI, and MPD after triplanar osteotomy. The length of the first metatarsal increased (10.9 ± 1.3 mm), as measured through three-dimensional images in the triplanar osteotomy group. The length was calculated as follows: H = L2 * Tan θ ≈ L/COS β * Tan θ.
The new triplanar osteotomy technique is safe and effective for treating HV, and in simulation experiments reveals potential benefits of correction and preventing transfer metatarsalgia.
介绍一种治疗拇外翻（HV）的新方法——三平面 Chevron 截骨术。
这是一项回顾性研究。本研究回顾性评估了 2018 年 6 月 1 日至 2020 年 6 月 1 日期间 HV 伴疼痛胼胝患者的 CT 数据。评估了 49 例连续 HV 患者（59 只脚）的 CT 数据。手术时的平均年龄为 49.6 岁（范围 30-63 岁）。 Chevron 截骨术的顶点位于第一跖骨的中心，定义为与第四跖骨骨中央点垂直的线。跖向斜 Chevron 截骨术（POCO）的切骨面定义如下： Chevron 截骨术伴有 20°跖向斜度。使用 POCO 方法进行三平面截骨，方向向远端倾斜 10°。在手术前后均计算了跖骨间角（IMA）、HV 角（HVA）、第二跖骨的投影（PSM）、跖骨突出指数（MPI）和跖骨突出距离（MPD）。使用方程测量和计算第一跖骨的长度。
结果显示，三组患者的 HVA 术后均明显降低（32.7°±4.6° vs 14.9°±2.1°，t=25.583，P<0.001）。IMA 也明显降低（14.7°±2.0°），与术前（8.0°±1.1°，t=22.739，P<0.001）相比。与传统截骨术和 POCO 相比，三平面截骨术在矢状面上矫正 HVA（14.5°±1.7° vs 14.9°±2.1°，t=1.835，P=0.072）和 IMA（8.1°±1.1° vs 8.0°±1.1°，t=-0.97，P=0.336）的畸形无差异。三平面截骨术后，PSM、MPI 和 MPD 均有统计学意义的降低。第一跖骨的长度增加（10.9±1.3mm），通过三平面截骨组的三维图像测量。长度计算如下：H=L2Tanθ≈L/CosβTanθ。
新型三平面截骨术治疗 HV 安全有效，模拟实验显示其具有矫正和预防转移性跖痛的潜在优势。
