Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK.
Arch Orthop Trauma Surg. 2023 Jul;143(7):3997-4007. doi: 10.1007/s00402-022-04693-x. Epub 2022 Nov 10.
It is unclear whether lateral soft tissue release (LSTR) is required as part of percutaneous hallux valgus (PHV) surgery. The primary aim of this systematic review was to assess whether LSTR reduces the risk of recurrence of hallux valgus deformity. The secondary aims were to assess if LSTR increases the risk of complications, improves the clinical outcome and leads to a greater radiographic correction.
We performed a PRISMA-compliant PROSPERO-registered systematic review, pooling clinical papers reporting results after PHV surgery into two categories (PHV with (Group 1, G1) and without LSTR (Group 2, G2)) and comparing them. Data regarding the study design, demographics, the surgical procedure and the clinical and radiological outcome were extracted and compared. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS).
Sixteen studies were selected (G1:594 feet; G2:553 feet). The pooled proportion of recurrence at a minimum 21-month follow-up (2%, 95%CI 0-3 vs 2%, 95%CI 0-5; p = 0.70) did not differ in the two groups. Similarly, the pooled proportion of complications (27%, 95%CI 17-38 vs 25%, 95%CI 12-37; p = 0.79) was similar. The pre- (p = 0.23) and post-operative AOFAS scores (p = 0.16), the pre-(HVA: p = 0.23) (IMA: p = 0.94) and post-operative radiological angles (HVA: p = 0.47) (IMA: p = 0.2) and the methodological quality of studies (p = 0.2) did not differ either between G1 and G2.
There is no evidence that LSTR performed during percutaneous HV surgery reduces the risk of recurrence of the deformity at a mean 4-year follow-up nor improves the clinical and radiological outcome.
Level IV systematic review of Level I to IV studies.
在经皮拇外翻（PHV）手术中，是否需要行外侧软组织松解（LSTR）尚不清楚。本系统评价的主要目的是评估 LSTR 是否降低拇外翻畸形复发的风险。次要目的是评估 LSTR 是否增加并发症的风险，改善临床结果，并导致更大的放射学矫正。
我们进行了符合 PRISMA 标准的 PROSPERO 注册系统评价，将报告 PHV 手术后结果的临床论文分为两组（行 LSTR 组[G1，594 足]和不行 LSTR 组[G2，553 足]）进行比较。提取并比较研究设计、人口统计学、手术过程以及临床和放射学结果的数据。使用改良 Coleman 方法学评分（mCMS）评估偏倚风险。
共选择了 16 项研究（G1：594 足；G2：553 足）。两组在至少 21 个月的随访时复发的比例（2%，95%CI 0-3%与 2%，95%CI 0-5%；p=0.70）没有差异。同样，并发症的比例（27%，95%CI 17-38%与 25%，95%CI 12-37%；p=0.79）也相似。术前（p=0.23）和术后 AOFAS 评分（p=0.16）、术前（HVA：p=0.23）（IMA：p=0.94）和术后放射学角度（HVA：p=0.47）（IMA：p=0.2）以及研究的方法学质量（p=0.2）在 G1 和 G2 之间也没有差异。
没有证据表明经皮 HV 手术中行 LSTR 可降低畸形平均 4 年随访时的复发风险，也不能改善临床和放射学结果。
对 I 级至 IV 级研究进行的 IV 级系统评价。
