远端V形截骨术增加拇外翻的解剖学跖间角。
Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus.
作者信息
Chan Jeremy Y, Noori Naudereh, Chen Stephanie, Pfeffer Glenn B, Charlton Timothy P, Thordarson David B
机构信息
Cedars-Sinai Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA, USA.
出版信息
Foot Ankle Orthop. 2020 Oct 14;5(4):2473011420960710. doi: 10.1177/2473011420960710. eCollection 2020 Oct.
BACKGROUND
Distal chevron metatarsal osteotomy (DCO) is a common technique to address hallux valgus (HV), which involves coronal translation of the capital fragment resulting in a nonanatomic first metatarsal. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic vs the mechanical axis of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis.
METHODS
This was a retrospective case series of consecutive patients who underwent DCO for HV. The primary outcomes were the change in anatomic first-second intermetatarsal angle (a1-2IMA) vs mechanical first-second intermetatarsal angle (m1-2IMA). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position.
RESULTS
40 feet were analyzed with a mean follow-up of 21.2 weeks. The a1-2IMA increased significantly (mean, 4.1 degrees) whereas the m1-2IMA decreased significantly (mean, 4.6 degrees) following DCO. There was a significant improvement in HVA (mean, 12.5 degrees). Medial sesamoid position was improved in 21 feet (52.5%). Patients with no improvement in sesamoid position were found to have a larger increase in a1-2IMA (mean, 4.7 vs 3.5 degrees, = .03) and less improvement in m1-2IMA (mean, 3.8 vs 5.2 degrees, = .02) compared to patients with improvement in sesamoid position.
CONCLUSION
Distal chevron osteotomy for HV was associated with worsening of the anatomic axis of the first metatarsal despite improvements in the mechanical metatarsal axis, HVA, and medial sesamoid position. Greater worsening of the anatomic axis was associated with less improvement of sesamoid position. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
背景
远端V形截骨术（DCO）是治疗拇外翻（HV）的常用技术，该手术涉及近端骨块的冠状面移位，导致第一跖骨解剖结构异常。本研究的目的是评估DCO对第一跖骨解剖轴与机械轴的影像学影响。我们的假设是，接受DCO手术的患者机械性跖骨轴会有所改善，但解剖轴会恶化。
方法
这是一项对连续接受DCO治疗HV患者的回顾性病例系列研究。主要观察指标是解剖学第一-二跖骨间角（a1-2IMA）与机械性第一-二跖骨间角（m1-2IMA）的变化。次要观察指标包括拇外翻角（HVA）和内侧籽骨位置的变化。
结果
共分析了40只足，平均随访21.2周。DCO术后，a1-2IMA显著增加（平均4.1度），而m1-2IMA显著降低（平均4.6度）。HVA有显著改善（平均12.5度）。21只足（52.5%）的内侧籽骨位置得到改善。与籽骨位置改善的患者相比，籽骨位置未改善的患者a1-2IMA增加幅度更大（平均4.7度对3.5度，P = 0.03），m1-2IMA改善幅度更小（平均3.8度对5.2度，P = 0.02）。
结论
尽管机械性跖骨轴、HVA和内侧籽骨位置有所改善，但HV的远端V形截骨术与第一跖骨解剖轴的恶化有关。解剖轴恶化越严重，籽骨位置改善越少。我们的研究结果可能提示存在跖骨间不稳定，这可能会限制DCO在矫正更严重畸形的HV中的作用，并为HV复发提供一种机制。
证据水平
IV级，回顾性病例系列研究。
Zotero 插件