Centre Médico-Universitaire du Pied, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France.
Centre de Chirurgie Orthopédique et Sportive, Centre du pied, Mérignac, France.
Foot Ankle Int. 2022 Apr;43(4):463-473. doi: 10.1177/10711007211052298. Epub 2021 Nov 8.
Hallux rigidus is the second most frequent pathology of the first ray. Surgical options for degenerative metatarsophalangeal joint disease are either joint destructive or conservative procedures. The hypothesis was that oblique distal shortening osteotomy of the first metatarsal is an effective conservative technique for the management of stage 1 to 3 hallux rigidus.
We conducted a retrospective cohort study of 87 feet with Coughlin and Shurnas's stage 1-3 hallux rigidus, operated between 2009 and 2019. The cohort consisted in 72 patients (87 feet) with an average age of 57±9 (30/79) years; 22 of 87 (25.3%) feet had the first metatarsal surgery performed in isolation; 65 of 87 (74.7%) had concomitant forefoot procedures, including 31 of 87 (35.6%) with Akin phalangeal osteotomies and 34 of 87 (39.1%) with Moberg phalangeal osteotomies.We evaluated the American Orthopaedic Foot & Ankle Society (AOFAS) Scale, subjective satisfaction, joint amplitudes, shortening rate, and occurrence of postoperative complications with a mean follow-up of 51 months (16/134).
The AOFAS score increased from 54.2±11.3 (25/70) preoperatively to 92.2±7.8 (62/100) postoperatively ( < .001). Patients reported excellent or good outcome in 95.4% of cases. The 40-point self-reported pain subscale score improved from 19.6 (± 10.0) to 37.4 (± 5.4), < .001.The overall range of motion increased from 61±21 (20/110) degrees to 69±17 (35/120) degrees ( < .001). The mean first metatarsal shortening rate (SR) was 9.6%. Neither the Coughlin grade, the metatarsal index, or the SR influenced the AOFAS score. At 6-month follow-up, 15 patients had transfer metatarsalgia compared with 5 at last follow-up without requiring another surgical procedure. The risk was not significantly different according to Coughlin's stage, preoperative metatarsal index, or SR.
Oblique distal osteotomy of the first metatarsal for stage 1-3 hallux rigidus, often in combination with other first ray procedures, performed well during our follow-up time period, with a high subjective satisfaction rate and few complications.
Level III, retrospective cohort study.
僵硬拇趾是第一跖骨最常见的第二种病理。退行性跖趾关节疾病的手术选择要么是关节破坏性的，要么是保守性的。假设第一跖骨的斜向远端缩短截骨术是治疗 1 期至 3 期僵硬拇趾的有效保守技术。
我们对 2009 年至 2019 年间接受 Coughlin 和 Shurnas 1-3 期僵硬拇趾手术的 87 例（87 足）进行了回顾性队列研究。该队列包括 72 名患者（87 足），平均年龄 57±9（30/79）岁；22/87（25.3%）足单独进行了第一跖骨手术；65/87（74.7%）同时进行了前足手术，其中 31/87（35.6%）行 Akin 趾骨切开术，34/87（39.1%）行 Moberg 趾骨切开术。我们评估了美国矫形足踝协会（AOFAS）量表、主观满意度、关节活动度、缩短率和术后并发症的发生率，平均随访 51 个月（16/134）。
AOFAS 评分从术前的 54.2±11.3（25/70）增加到术后的 92.2±7.8（62/100）（ <.001）。95.4%的患者报告了良好或优秀的结果。40 分自我报告疼痛亚量表评分从 19.6（±10.0）改善至 37.4（±5.4）， <.001。整体活动度从 61±21（20/110）度增加至 69±17（35/120）度（ <.001）。第一跖骨平均缩短率（SR）为 9.6%。Coughlin 分级、跖骨指数或 SR 均不影响 AOFAS 评分。在 6 个月随访时，15 例患者出现转移性跖痛，而末次随访时仅 5 例需要再次手术。根据 Coughlin 分期、术前跖骨指数或 SR，风险无显著差异。
第一跖骨的斜向远端截骨术用于治疗 1 期至 3 期僵硬拇趾，通常与其他第一跖骨手术联合进行，在我们的随访期间表现良好，具有较高的主观满意度和较少的并发症。
III 级，回顾性队列研究。
