Department of Orthopaedic Surgery, Orihuela Hospital, Orihuela, Alicante, Spain.
Department of Orthopaedic Surgery, Elda University Hospital Elda, Alicante, Spain.
Foot Ankle Surg. 2022 Jun;28(4):471-475. doi: 10.1016/j.fas.2021.12.008. Epub 2021 Dec 23.
The objective was to evaluate the influence of the postoperative sesamoid position as measured with conventional radiographs on the patient-reported outcome after scarf osteotomy. The hypothesis was that incomplete reduction of the sesamoid would result in a decreased functional outcome.
Eighty-two patients who underwent scarf osteotomy for hallux valgus were prospectively assessed for up to two postoperative years. The Self-Reported Foot and Ankle Score (SEFAS) was used to assess the quality of life, and the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS) for the functional outcome. A visual analogue scale (VAS) assessed pain, and Likert scale for patient satisfaction. Radiologically, hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), and sesamoid position were analyzed. According to the final sesamoid position, patients were classified as normal position (48 patients) and outlier position (34 patients). A power analysis, conventional and logistic regression statistical analysis were performed.
At the final follow-up, significant improvements in all clinical scores were observed for both groups (p = 0.001) with no significant difference in AOFAS score (p = 0.413), but SEFAS score (p = 0.023), VAS-pain (p = 0.006), and satisfaction (p = 0.014) were significantly better in the normal group than in the outlier group. There were significant differences between groups in final HVA (p = 0.042) and IMA (p = 0.040). In multivariate analysis, only lower VAS-pain score (OR 0.4, 95% CI 0.2-0.6; p = 0.039) and normal sesamoid position (OR 2.4, 95% CI 1.6-3.2; p = 0.012) were significant predictor of patient satisfaction.
At two postoperative years, normal sesamoid position as measured on weight-bearing radiographs was associated with lower pain and better patient satisfaction in patients underwent scarf osteotomy for moderate to severe hallux valgus.
本研究旨在评估术后籽骨位置（通过常规 X 线片测量）对拇外翻切开术患者报告结局的影响。我们假设，如果籽骨未完全复位，将会导致功能结果下降。
前瞻性评估了 82 例接受拇外翻切开术的患者，随访时间最长达 2 年。采用足踝部自我报告评分（SEFAS）评估生活质量，美国矫形足踝协会拇趾-跖骨-趾骨评分（AOFAS）评估功能结果。视觉模拟评分（VAS）评估疼痛，Likert 量表评估患者满意度。影像学上分析了拇外翻角（HVA）、第一-二跖骨间角（IMA）和籽骨位置。根据最终籽骨位置，患者分为正常位置（48 例）和异常位置（34 例）。进行了功效分析、常规和逻辑回归统计分析。
在最终随访时，两组的所有临床评分均显著改善（p=0.001），但 AOFAS 评分无显著差异（p=0.413），而 SEFAS 评分（p=0.023）、VAS 疼痛评分（p=0.006）和满意度（p=0.014）在正常组明显优于异常组。两组最终 HVA（p=0.042）和 IMA（p=0.040）存在显著差异。多变量分析显示，只有较低的 VAS 疼痛评分（OR 0.4，95%CI 0.2-0.6；p=0.039）和正常籽骨位置（OR 2.4，95%CI 1.6-3.2；p=0.012）是患者满意度的显著预测因素。
在术后 2 年，负重位 X 线片上测量的正常籽骨位置与中重度拇外翻切开术后患者的低疼痛和更好的患者满意度相关。
