Department of Traumatology and Orthopedic Surgery, Hospital Doctor Peset, Valencia, Spain.
Institute for Research on Musculoskeletal Disorders, School of Medicine and Health Sciences, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain.
J Orthop Surg Res. 2022 Feb 8;17(1):80. doi: 10.1186/s13018-022-02974-0.
Distal chevron osteotomy is commonly used for the operative treatment of hallux valgus (HV). However, there are several operative procedures that can be used to treat HV. The aim of this meta-analysis was to compare the efficacy of distal chevron osteotomy with different operative procedures.
A systematic search was conducted using the MEDLINE and EMBASE databases to identify randomized clinical trials (RCTs). The variables were radiological (hallux metatarsal phalangeal angle [HVA] and intermetatarsal angle [IMA]) and clinical (American Orthopaedic Foot & Ankle Society Score [AOFAS]). Heterogeneity was assessed with chi and I statistics. A random effects model was used for significant heterogeneity. Publication bias was evaluated with funnel plots.
Ten studies involving 985 patients were evaluated in the meta-analysis. Distal chevron osteotomy was associated with a mean IMA correction 2.18° greater than the scarf procedure (MD - 2.18; 95% CI - 3.67, - 0.69; p = 0.004; I = 0%). In addition, the proximal chevron was associated with a mean IMA correction 1.08° greater than the distal chevron (MD - 1.08; 95% CI - 1.86, - 0.29; p = 0.007; I = 0%). The AOFAS assessment showed an overall advantage of 3.2 points in favor of the Lingdren group compared with distal chevron osteotomy (MD 3.20; 95% CI 0.37, 6.04; p = 0.03; I = 0%).
Our findings indicate that distal chevron osteotomy provides a greater HVA correction than scarf osteotomy, and proximal chevron provides a larger IMA correction than distal chevron osteotomy. Lingdren osteotomy provides a greater AOFAS correction than distal chevron osteotomy.
Level I, meta-analysis.
远端跖骨切开术常用于治疗拇外翻（HV）的手术治疗。然而，有几种手术方法可用于治疗 HV。本荟萃分析的目的是比较远端跖骨切开术与不同手术方法的疗效。
使用 MEDLINE 和 EMBASE 数据库进行系统搜索，以确定随机临床试验（RCT）。变量为影像学（跖骨间角[HVA]和跖骨间角[IMA]）和临床（美国矫形足踝协会评分[AOFAS]）。使用 chi 和 I 统计量评估异质性。对于显著异质性，使用随机效应模型。使用漏斗图评估发表偏倚。
荟萃分析评估了 10 项涉及 985 名患者的研究。与 Scarf 手术相比，远端跖骨切开术的 IMA 平均矫正值大 2.18°（MD-2.18；95%CI-3.67，-0.69；p=0.004；I=0%）。此外，近端跖骨切开术的 IMA 平均矫正值比远端跖骨切开术大 1.08°（MD-1.08；95%CI-1.86，-0.29；p=0.007；I=0%）。AOFAS 评估显示，与远端跖骨切开术相比，Lingdren 组总体优势为 3.2 分（MD3.20；95%CI0.37，6.04；p=0.03；I=0%）。
我们的研究结果表明，与 Scarf 手术相比，远端跖骨切开术可提供更大的 HVA 矫正，而近端跖骨切开术可提供更大的 IMA 矫正。与远端跖骨切开术相比，Lingdren 切开术可提供更大的 AOFAS 矫正。
1 级，荟萃分析。
