Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea.
Department of Otrhopedic Surgery, Myungji Hospital, Goyang, Korea.
Clin Orthop Surg. 2021 Mar;13(1):110-116. doi: 10.4055/cios20003. Epub 2021 Feb 15.
Problems associated with hallux valgus deformity correction using Kirschner-wire (K-wire) fixation include pin pullout and loss of stability. These complications are pronounced in the osteopenic bone, and few reports have focused on pin versus screw fixation. We examined the use of additional screw fixation to avoid these problems. The aim of this study was to compare outcomes of K-wire fixation (KW) and a combined K-wire and screw fixation (KWS).
Two groups with hallux valgus deformity, who were treated with a proximal chevron metatarsal osteotomy (PCMO), were compared based on the fixation method used. The KW group included 117 feet of 98 patients, and the KWS group included 56 feet of 40 patients. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) hallux score, and patient satisfaction score were evaluated. Radiographically, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured.
The mean VAS score decreased from 6.3 preoperatively to 1.6 postoperatively in the KW group and from 5.7 preoperatively to 0.5 postoperatively in the KWS group ( < 0.001). The mean AOFAS scores of the KW and KWS groups improved from 59.4 and 58.2, respectively, to 88.9 and 95.3, respectively ( < 0.001). Eighty-five percent in the KW group and 93% in the KWS group were satisfied with surgery. Clinical differences were not significant. The mean HVAs decreased from 34.7° to 9.1° in the KW group and from 38.5° to 9.2° in the KWS group ( < 0.001). The mean IMA decreased from 14.5° (range, 11.8°-17.2°) to 6.4° (range, 2.7°-10.1°) in the KW group and from 18.0° (range, 14.8°-21.2°) to 5.3° (range, 2.5°-8.1°) in the KWS group ( < 0.001). When IMA values at the 3-month postoperative and the final follow-up were compared, the IMA was significantly increased only in the KW group ( < 0.001) and no difference was found in the KWS group ( = 0.280).
We found a statistically significant difference in the decrease in IMA between the 2 groups. We recommend the combined pin and screw fixation in PCMO to enhance fixation stability and prevent potential hallux valgus correction loss.
采用克氏针（K-wire）固定治疗拇外翻畸形时，存在针道并发症，包括针道移位和稳定性丧失。这些并发症在骨质疏松骨中更为明显，很少有报道关注针道固定与螺钉固定的比较。我们检查了附加螺钉固定以避免这些问题。本研究的目的是比较克氏针固定（KW）和克氏针加螺钉固定（KWS）的结果。
对两组接受近端楔形跖骨截骨术（PCMO）治疗的拇外翻畸形患者，根据固定方法进行比较。KW 组包括 98 例患者的 117 只脚，KWS 组包括 40 例患者的 56 只脚。临床方面，评估术前和最终随访时的视觉模拟量表（VAS）疼痛评分、美国矫形足踝协会（AOFAS）拇趾评分和患者满意度评分。影像学方面，测量拇外翻角（HVA）和跖骨间角（IMA）。
KW 组的 VAS 评分从术前的 6.3 分降至术后的 1.6 分，KWS 组从术前的 5.7 分降至术后的 0.5 分（均<0.001）。KW 组和 KWS 组的 AOFAS 评分分别从 59.4 和 58.2 提高到 88.9 和 95.3（均<0.001）。KW 组和 KWS 组分别有 85%和 93%的患者对手术满意，临床差异无统计学意义。HVA 的平均降幅在 KW 组为 34.7°至 9.1°，在 KWS 组为 38.5°至 9.2°（均<0.001）。IMA 的平均降幅在 KW 组为 14.5°（范围为 11.8°-17.2°）至 6.4°（范围为 2.7°-10.1°），在 KWS 组为 18.0°（范围为 14.8°-21.2°）至 5.3°（范围为 2.5°-8.1°）（均<0.001）。比较术后 3 个月和最终随访时的 IMA 值，仅 KW 组的 IMA 显著增加（<0.001），而 KWS 组无差异（=0.280）。
我们发现两组之间 IMA 减少的差异具有统计学意义。我们建议在 PCMO 中采用联合克氏针和螺钉固定以增强固定稳定性，防止潜在的拇外翻矫正丢失。
