Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.
Surgeon. 2021 Dec;19(6):e497-e506. doi: 10.1016/j.surge.2020.11.010. Epub 2021 Jan 7.
Failure of hallux valgus (HV) correction is not uncommon, and its management can be challenging. The available literature is not exhaustive. Therefore, we conducted a systematic review to investigate the current evidence on the role of revision surgery for failed HV correction, including clinical presentation, indications, surgical strategies and outcomes.
The present systematic review was performed according to the PRISMA guidelines. Pubmed, EMBASE, Google Scholar and Scopus online databases were accessed in November 2020. All the clinical studies on revision for failed HV correction were analysed, and only studies reporting quantitative data under the outcomes of interest were considered for inclusion.
Data from 20 studies (586 procedures) were retrieved. The HV angle, the intermetatarsal angle and the distal metatarsal articular angle were reduced of 17.8° (P < 0.001), 3.3° (P = 0.05) and 7.3° (P < 0.001) respectively. The American Orthopaedic Foot & Ankle Society score improved of 24.7% (P < 0.001). The visual analogue scale improved by 40.8% (P < 0.001). Dorsiflexion and plantar flexion of the first metatarso-phalangeal joint remained similar to their preoperative values (P = 0.2 and P = 0.4, respectively). After revision surgery the following complications were further detected: recurrences 5.1% (30 of 586 patients), non-unions 4.1% (24/586), additional surgical procedures 8.7% (51 of 586 patients).
Revision surgery for failed primary HV correction can yield satisfying results. Accurate preoperative planning is necessary to try and identify the causes of failure, and address them appropriately.
拇外翻（HV）矫形失败并不罕见，其治疗可能具有挑战性。现有文献并不详尽。因此，我们进行了系统评价，以研究revision surgery 治疗 HV 矫形失败的当前证据，包括临床表现、适应证、手术策略和结果。
本系统评价根据 PRISMA 指南进行。2020 年 11 月，检索了 Pubmed、EMBASE、Google Scholar 和 Scopus 在线数据库。分析了所有关于 revision surgery 治疗 HV 矫形失败的临床研究，仅纳入了报告感兴趣结局的定量数据的研究。
共检索到 20 项研究（586 例手术）的数据。HV 角、跖骨间角和远节跖骨关节角分别减少了 17.8°（P<0.001）、3.3°（P=0.05）和 7.3°（P<0.001）。美国矫形足踝协会评分提高了 24.7%（P<0.001）。视觉模拟评分（VAS）改善了 40.8%（P<0.001）。第一跖趾关节背屈和跖屈与术前相似（P=0.2 和 P=0.4）。revision surgery 后，进一步发现以下并发症：复发 5.1%（586 例患者中有 30 例）、不愈合 4.1%（586 例中有 24 例）、需额外手术 8.7%（586 例中有 51 例）。
revision surgery 治疗 HV 矫形初次失败可获得满意的结果。需要准确的术前规划，以尽力识别失败的原因，并适当地处理。
