Faculty of medicine, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Department of Orthopaedics, "Foisor" Orthopaedics Hospital, 020021 Bucharest, Romania.
Medicina (Kaunas). 2022 Mar 1;58(3):359. doi: 10.3390/medicina58030359.
Introduction: Minimally invasive surgical techniques for hallux valgus have gained popularity, showing good results characterized by smaller postoperative scars, less pain, lower infection risk, and fewer wound complications. Given the lack of evidence available in our country regarding this subject, especially about this type of surgical technique, our paper aims to compare open and MIS approaches for chevron osteotomy. We evaluated the outcome and complications after 12 months. Materials and Methods: We undertook a prospective, randomized, controlled, single-center study between October 2017 and December 2020. The patients were randomized into two groups: one group that received percutaneous chevron osteotomy (MIS), and the other, open chevron osteotomy (OC). For clinical assessment, we determined the function and the level of pain using the Visual Analogue Scale (VAS) and The American Orthopaedic Foot and Ankle Surgery score (AOFAS). The VAS scale was measured before the surgical procedure, at discharge, and at 3 weeks, 6 weeks, 6 months, and 12 months after surgery. The AOFAS score was calculated preoperatively and after 6 months. The hallux angle (HVA) and intramedullary angle (IMA) were measured preoperatively, and at 6 weeks, 6 months and 12 months. Results: We included 26 cases in the open chevron osteotomy group (24 female, 2 male) and 24 in the MIS group (24 female, 0 male). Both groups demonstrated improvements regarding the IMA and HVA at the last follow-up without any significant differences between the groups at the final assessment. The VAS showed significantly better post-operative results for the MIS group at discharge (p < 0.001) and 3 weeks (p < 0.001), 6 weeks (p < 0.001), and 6 months (p = 0.004) post-surgery. The AOFAS showed no significant differences either before or after surgery. Four cases with screw prominence were reported, three of which belonged to the MIS group. Only one case with metatarsalgia was found in the OC group. Conclusions: This paper demonstrates that minimally invasive chevron osteotomy has comparable results with open chevron osteotomy, even though surgical time and radiological exposure are significantly longer. More studies are required to evaluate the complications and the risk of recurrences.
微创外科技术治疗拇外翻已经越来越受欢迎，其具有术后疤痕小、疼痛轻、感染风险低、伤口并发症少等优点。由于我国在这方面的证据不足，特别是关于这种手术技术，我们的论文旨在比较开放和微创跖骨楔形截骨术（MIS）治疗鹅足骨的效果。我们评估了 12 个月后的结果和并发症。
我们于 2017 年 10 月至 2020 年 12 月进行了一项前瞻性、随机、对照、单中心研究。患者被随机分为两组：一组接受经皮鹅足骨楔形截骨术（MIS），另一组接受开放鹅足骨楔形截骨术（OC）。为了临床评估，我们使用视觉模拟量表（VAS）和美国矫形足踝外科学会评分（AOFAS）来确定功能和疼痛程度。VAS 量表在手术前、出院时以及术后 3 周、6 周、6 个月和 12 个月进行测量。AOFAS 评分在术前和术后 6 个月进行计算。术前、术后 6 周、6 个月和 12 个月测量拇外翻角（HVA）和髓内角（IMA）。
OC 组 26 例（24 例女性，2 例男性），MIS 组 24 例（24 例女性，0 例男性）。两组 IMA 和 HVA 在末次随访时均有改善，最终评估时两组间无显著差异。MIS 组在出院时（p < 0.001）和术后 3 周（p < 0.001）、6 周（p < 0.001）和 6 个月（p = 0.004）时 VAS 评分明显更好。AOFAS 评分在术前和术后均无显著差异。报告了 4 例螺钉突出，其中 3 例属于 MIS 组。OC 组仅发现 1 例跖痛。
本文表明，微创跖骨楔形截骨术与开放跖骨楔形截骨术具有相当的结果，尽管手术时间和放射暴露明显更长。需要更多的研究来评估并发症和复发的风险。
