微创V形截骨术与改良Lapidus手术相比的早期影像学结果。
Early Radiographic Outcomes of Minimally Invasive Chevron Bunionectomy Compared to the Modified Lapidus Procedure.
作者信息
Cody Elizabeth A, Caolo Kristin, Ellis Scott J, Johnson A Holly
机构信息
Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
出版信息
Foot Ankle Orthop. 2022 Jul 21;7(3):24730114221112103. doi: 10.1177/24730114221112103. eCollection 2022 Jul.
BACKGROUND
Minimally invasive (MIS) bunion surgery has become increasingly popular. Although early reports on outcomes have been encouraging, no study to date has compared outcomes from the MIS chevron and Akin procedures to the modified Lapidus procedure. Our primary aim was to compare early radiographic outcomes of the MIS chevron and Akin osteotomies to those of the modified Lapidus procedure in patients with comparable deformities, and secondarily to compare clinical outcomes.
METHODS
Patients were retrospectively reviewed for inclusion from a prospectively collected foot and ankle registry. Patients were eligible if they underwent either the MIS bunionectomy or modified Lapidus procedure and had preoperative and minimum 5-month postoperative weightbearing radiographs. Forty-one patients who underwent MIS bunionectomy were matched to 41 patients who underwent Lapidus bunionectomy based on radiographic parameters. Demographics, radiographic parameters, complications, reoperations, and PROMIS scores were compared between groups.
RESULTS
Both groups achieved similar radiographic correction. There was no significant difference in pre- or postoperative PROMIS scores between groups. Procedure duration was significantly faster in the MIS group ( < .001). Bunion recurrence (hallux valgus angle ≥20 degrees) occurred in 1 MIS patient and 2 Lapidus patients, with all patients asymptomatic. The most common reason for reoperation was removal of hardware (4 patients in the MIS group, 2 patients in the Lapidus group).
CONCLUSION
This is the first study to our knowledge to compare early radiographic outcomes between MIS bunionectomy and the modified Lapidus procedure in patients matched for bunion severity. We found that patients with similar preoperative deformities experience similar radiographic correction following MIS chevron and Akin osteotomies vs modified Lapidus bunionectomy. Further research is needed to investigate satisfaction differences between the procedures, longer-term outcomes, and which deformities are best suited to each procedure.
LEVEL OF EVIDENCE
Level III, Retrospective case control study.
背景
微创拇外翻手术越来越受欢迎。尽管早期关于手术效果的报告令人鼓舞，但迄今为止，尚无研究将微创 Chevron 和 Akin 手术的结果与改良 Lapidus 手术的结果进行比较。我们的主要目的是比较具有相似畸形的患者中，微创 Chevron 和 Akin 截骨术与改良 Lapidus 手术的早期影像学结果，其次是比较临床结果。
方法
对前瞻性收集的足踝登记册中的患者进行回顾性审查以纳入研究。如果患者接受了微创拇外翻切除术或改良 Lapidus 手术，并且有术前和术后至少 5 个月的负重 X 光片，则符合纳入标准。根据影像学参数，将 41 例行微创拇外翻切除术的患者与 41 例行 Lapidus 拇外翻切除术的患者进行匹配。比较两组之间的人口统计学、影像学参数、并发症、再次手术情况和 PROMIS 评分。
结果
两组均获得了相似的影像学矫正。两组术前或术后的 PROMIS 评分无显著差异。微创组的手术时间明显更快（P <.001）。1 例微创患者和 2 例 Lapidus 患者出现拇外翻复发（拇外翻角≥20 度），所有患者均无症状。再次手术的最常见原因是取出内固定物（微创组 4 例，Lapidus 组 2 例）。
结论
据我们所知，这是第一项比较拇外翻严重程度匹配的患者中，微创拇外翻切除术与改良 Lapidus 手术早期影像学结果的研究。我们发现，术前畸形相似的患者在接受微创 Chevron 和 Akin 截骨术与改良 Lapidus 拇外翻切除术后，影像学矫正情况相似。需要进一步研究来调查两种手术之间的满意度差异、长期结果以及哪种畸形最适合每种手术。
证据级别
III 级，回顾性病例对照研究。
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