拇外翻外侧松解术的矫正潜力：采用背侧入路的微创与开放手术技术的比较解剖学研究
The Correction Potential of the Lateral Release of the Hallux Valgus: A Comparative Anatomical Study of Minimally Invasive Versus Open Surgical Technique Using a Dorsal Approach.
作者信息
Klos Kajetan, Lenz Mark, Hofmann Gunther O, Schubert Wiebke, Knobe Matthias, Roth Klaus Edgar, Simons Paul, Aurich Matthias
机构信息
Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany.
Gelenkzentrum Rhein-Main, Fuß- Und Sprunggelenkschirurgie, Frankfurter Straße 94, 65239 Hochheim, Germany.
出版信息
Indian J Orthop. 2022 Jan 13;56(5):887-894. doi: 10.1007/s43465-021-00575-3. eCollection 2022 May.
BACKGROUND
Lateral release (LR) is an integral part of surgical correction of hallux valgus. A comparison was made between the open and minimally invasive LR techniques using a dorsal approach. The reliability and safety of the two methods were compared. Besides, the release of specific structures was investigated with special emphasis on ascertaining if the release was partial or a total one.
METHODS
In this study on cadavers, LR was performed on nine pairs of foot and ankle specimens. The group assignments were randomized for each case. The operations were followed by anatomical preparation, data collection, photo documentation, and statistical analysis.
RESULTS
A statistically significant advantage was observed with the open dorsal approach as there was a complete release of the adductor hallucis muscle from the lateral sesamoid and the lateral metatarsosesamoid ligament ( = 0.015 in each case). In terms of releasing the adductor hallucis muscle from the proximal phalanx, the lateral joint capsule, and the lateral collateral ligament, none of the investigated procedures showed better performance. However, open dorsal access tends to show a higher degree of release more frequently.
CONCLUSIONS
Splitting of the lateral joint capsule, including the lateral collateral ligament and lateral metatarsosesamoid ligament via the dorsal approach can be performed reliably and completely using the open surgical technique. The open dorsal technique shows better rates of detachment when the adductor hallucis muscle is released from the lateral sesamoid. Both techniques resulted in incomplete release of the adductor hallucis muscle from the proximal phalanx.
STUDY TYPE
Therapeutic-investigating the results of a treatment.
LEVEL OF EVIDENCE
II (Prospective cohort study).
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s43465-021-00575-3.
背景
外侧松解术（LR）是拇外翻手术矫正的一个重要组成部分。采用背侧入路对开放式和微创LR技术进行了比较。比较了两种方法的可靠性和安全性。此外，还对特定结构的松解进行了研究，特别强调确定松解是部分性的还是完全性的。
方法
在这项针对尸体的研究中，对9对足踝标本进行了LR。每组病例的分配是随机的。手术后进行解剖学准备、数据收集、照片记录和统计分析。
结果
开放式背侧入路具有统计学上的显著优势，因为拇收肌从外侧籽骨和外侧跖籽韧带完全松解（每种情况均为P = 0.015）。在将拇收肌从近节趾骨、外侧关节囊和外侧副韧带松解方面，所研究的任何手术方法均未表现出更好的效果。然而，开放式背侧入路更倾向于更频繁地显示出更高程度的松解。
结论
通过背侧入路切开包括外侧副韧带和外侧跖籽韧带在内的外侧关节囊，采用开放式手术技术可以可靠且完全地进行。当拇收肌从外侧籽骨松解时，开放式背侧技术显示出更好的分离率。两种技术均导致拇收肌从近节趾骨的不完全松解。
研究类型
治疗性——研究一种治疗方法的结果。
证据水平
II（前瞻性队列研究）。
补充信息
在线版本包含可在10.1007/s43465-021-00575-3获取的补充材料。
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