Orthopaedic Surgery Department, Sant Celoni Hospital, Sant Celoni, Spain; Department of Medical Sciences, Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Faculty of Medicine, University of Girona, 77 Emili Grahit St, 17003, Girona, Spain.
Department of Medical Sciences, Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Faculty of Medicine, University of Girona, 77 Emili Grahit St, 17003, Girona, Spain.
Orthop Traumatol Surg Res. 2023 Dec;109(8):103266. doi: 10.1016/j.otsr.2022.103266. Epub 2022 Mar 4.
Although percutaneous hallux valgus surgery is increasing in popularity, concerns about safety regarding neurovascular and tendinous structures remain. The first aim of this body-donor study was to evaluate the safety of three common percutaneous portals. Secondly, to evaluate percutaneous surgery effectiveness in completing adductor tendon release and first ray osteotomies.
Twenty body-donor feet were included and underwent three percutaneous procedures, which are commonly performed in combination: distal metatarsal osteotomy, proximal phalanx osteotomy and adductor tendon release. After surgery, the distance between surgical portals and relevant neurovascular structures was measured. Damage to this neurovascular structures, tendons or articular cartilage was noted. Completion of adductor tendon release and osteotomies was verified.
The medial dorsal digital nerve of the hallux was damaged in two specimens. Mild peritendon damage was observed in two feet. The rest of neurovascular and tendinous structures were intact. No cartilage damage was observed. The distance between the adductor tenotomy portal and the lateral dorsal digital nerve of the hallux and the first dorsal metatarsal artery was 3.3mm (SD 1.4) and 2.4mm (SD 1.8), respectively. Complete adductor tenotomy was achieved in 14 feet.
The structure with the highest risk of damage during percutaneous hallux valgus surgery is the medial dorsal digital nerve. The lateral dorsal digital nerve and the first dorsal metatarsal artery might be at risk due to the small distance to the adductor tendon release portal. A deep anatomical knowledge and a meticulous surgical technique are required to avoid lesions to neurovascular and tendinous structures.
V, Cadaveric study.
尽管经皮踇外翻手术越来越受欢迎，但对于神经血管和肌腱结构的安全性仍存在担忧。本尸体供体研究的首要目的是评估三种常见经皮入路的安全性。其次，评估经皮手术在完成内收肌腱松解和第一跖骨截骨术方面的有效性。
本研究共纳入 20 例尸体供体足，接受了三种常见的联合经皮手术：跖骨远端截骨术、近节趾骨截骨术和内收肌腱松解术。手术后，测量手术入路与相关神经血管结构之间的距离。记录神经血管结构、肌腱或关节软骨的损伤情况。验证内收肌腱松解和截骨术的完成情况。
2 例标本中踇趾背内侧皮神经受损。2 例出现轻度腱周损伤。其余神经血管和肌腱结构完整。未观察到软骨损伤。内收肌腱切断术入路与踇趾背外侧皮神经和第一跖背动脉之间的距离分别为 3.3mm（SD 1.4）和 2.4mm（SD 1.8）。14 例足完全完成内收肌腱松解。
经皮踇外翻手术中最容易受损的结构是踇背内侧皮神经。由于与内收肌腱切断术入路的距离较小，背外侧皮神经和第一跖背动脉可能存在风险。需要深入的解剖学知识和细致的手术技术，以避免神经血管和肌腱结构的损伤。
V，尸体研究。
