Private Practice, Ciudad Autónoma de Buenos Aires, Argentina.
Internal Medicine Research Unit, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Argentina.
Foot Ankle Int. 2022 Nov;43(11):1438-1449. doi: 10.1177/10711007221118568. Epub 2022 Aug 29.
The treatment for severe hallux valgus deformity presents a challenge with high risk of complications. Third generation MIS techniques have increased their publications in recent years. The aim was to compare clinical and radiologic outcomes in moderate and severe cases and report minor and major complications.
Retrospective series of cases with prospective data collection of 156 consecutive feet that underwent percutaneous double first metatarsal osteotomy (PEDO) and first phalanx osteotomy between 2008 and 2019 for moderate (hallux valgus angle [HVA] between ≥20 and <40 degrees and/or intermetatarsal angle [IMA] <16 degrees) and severe (HVA ≥40 degrees and/or IMA ≥16 degrees) hallux valgus deformities. Primary outcomes included radiographic and clinical parameters. Secondary outcomes included minor and major complications.
A total of 156 procedures were performed in 128 patients. Mean age was 54.3 years (SD 14.3) (range, 19-82 years), median follow-up was 22.6 months (range, 12-96 months). Radiographic changes pre- to postoperation were as follows: HVA changed from 38.2 (SD 10.1) degrees to 11.2 (SD 8.3) degrees ( < .001), IMA from 14.7 (SD 3.2) degrees to 7.9 (SD 3.7) degrees ( < .001), and distal articular metatarsal angle from 19.7 (SD 6.3) degrees to 8.8 (SD 5.7) degrees ( < .001) after PEDO technique. Clinical changes pre- to postoperation were as follows: American Orthopaedic Foot & Ankle Society ankle-hindfoot scale scores improved from 47.3 (SD 16.5) to 87 (SD 11.6) ( < .001) and visual analog scale scores from 5 (2.7) to 0.9 (1.3) ( < .001). The satisfaction rate was 97% in the total sample. Recurrence rate (HVA ≥20 degrees) was 7.7%. Hallux varus (HVA <0 degrees) occurred in 5.8%, acute osteomyelitis in 1.3%, partial avascular necrosis in 0.6%, screw removal in 0.6%, and reoperation in 1.9%. No nonunion was observed.
Clinical and radiographic parameters improved significantly, with a minimum of 12 months of follow-up in moderate and severe hallux valgus. Long experience in percutaneous surgery and specific instruments are needed for this technique. Recurrence was linked to preoperative HVA ≥40 degrees and postoperative tibial sesamoid position; Hallux varus was linked to lateral soft tissue release.
Level IV, case series.
严重拇外翻畸形的治疗具有很高的并发症风险。第三代微创技术近年来发表的文献有所增加。目的是比较中重度病例的临床和影像学结果，并报告小的和大的并发症。
回顾性系列病例，前瞻性收集了 2008 年至 2019 年间 156 例连续接受经皮第一跖骨双截骨术（PEDO）和第一跖骨截骨术的病例，用于治疗中度（拇外翻角[HVA]≥20 度且<40 度和/或跖骨间角[IMA] <16 度）和重度（HVA ≥40 度和/或 IMA ≥16 度）拇外翻畸形。主要结局包括影像学和临床参数。次要结局包括小的和大的并发症。
128 例患者共完成 156 例手术。平均年龄 54.3 岁（标准差 14.3）（范围，19-82 岁），中位随访时间为 22.6 个月（范围，12-96 个月）。术前至术后的影像学变化如下：HVA 从 38.2（标准差 10.1）度变为 11.2（标准差 8.3）度（<0.001），IMA 从 14.7（标准差 3.2）度变为 7.9（标准差 3.7）度（<0.001），远端关节跖骨角从 19.7（标准差 6.3）度变为 8.8（标准差 5.7）度（<0.001）。术后 PEDO 技术。术前至术后的临床变化如下：美国矫形足踝协会踝关节后足量表评分从 47.3（标准差 16.5）提高到 87（标准差 11.6）（<0.001），视觉模拟评分从 5（2.7）提高到 0.9（1.3）（<0.001）。总样本的满意度为 97%。复发率（HVA≥20 度）为 7.7%。拇内翻（HVA<0 度）发生率为 5.8%，急性骨髓炎发生率为 1.3%，部分性骨坏死发生率为 0.6%，螺钉取出率为 0.6%，再次手术率为 1.9%。未观察到骨不连。
在中重度拇外翻中，至少 12 个月的随访可显著改善临床和影像学参数。微创技术需要丰富的经验和特定的器械。复发与术前 HVA≥40 度和术后胫骨籽骨位置有关；拇内翻与外侧软组织松解有关。
IV 级，病例系列。
