Department of Orthopedic Surgery, Rouen University Hospital, France.
CETAPS Laboratory - EA 3832, Faculty of Sports Sciences, University of Rouen Normandy, Mont Saint Aignan, France.
Foot Ankle Int. 2023 Mar;44(3):210-222. doi: 10.1177/10711007231152487. Epub 2023 Mar 1.
Recurrence of hallux valgus (HV) following corrective surgery is a frequent concern. A recent systematic review estimated recurrence of HV in only 4.9%, which may be an underestimation, as most included studies had short- to mid-term follow-up. The purpose of this systematic review and meta-analysis was to assess long-term outcomes of distal osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis, and to assess HV recurrence rates reported in studies that had a minimum follow-up of 5 years.
This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of distal osteotomies of the M1 for noninflammatory and nondegenerative HV at a minimum follow-up of 5 years.
We found 17 eligible studies comprising 18 data sets, reporting outcomes of 4 categories of osteotomies: Chevron, Mitchell, Bösch, and "others." The HV recurrence rate was 64% considering the threshold of >15 degrees hallux valgus angle (HVA), 10% having >20 degrees, and 5% having >25 degrees.
At a minimum of 5 years following distal osteotomies of the M1, the mean weighted postoperative HVA was significantly higher for Mitchell osteotomies compared with the 3 other osteotomies reviewed. There were otherwise no significant differences in recurrence rates using the 3 HVA thresholds, or intermetatarsal angle among any of the surgical techniques reported in 2 or more studies. The pooled HV recurrence rates considering the various thresholds of HVA were as follows: 64% having >15 degrees, 10% having >20 degrees, and 5% having >25 degrees. The recurrence rates in the long term for all categories of surgical procedures suggest that better understanding of pathogenesis and prognosis of HV is required before modifying or introducing new surgical techniques.
Level IV, meta-analysis.
拇外翻（HV）矫正手术后的复发是一个常见的关注点。最近的一项系统评价估计 HV 的复发率仅为 4.9%，这可能是一个低估，因为大多数纳入的研究都有短期到中期的随访。本系统评价和荟萃分析的目的是评估无炎症性疾病或退行性关节炎的第一跖骨（M1）远端骨切开术治疗 HV 的长期结果，并评估至少随访 5 年的研究报告的 HV 复发率。
本系统评价符合 PRISMA 指南。作者使用 PubMed、Embase 和 Cochrane 对照试验中心注册数据库进行了搜索。研究报告了 M1 远端骨切开术治疗非炎症性和非退行性 HV 的结果，至少随访 5 年。
我们发现了 17 项符合条件的研究，包括 18 个数据集，报告了 4 类截骨术的结果：Chevron、Mitchell、Bösch 和“其他”。考虑到 HV 角>15 度的阈值，HV 复发率为 64%，>20 度的复发率为 10%，>25 度的复发率为 5%。
在 M1 远端骨切开术至少 5 年后，与其他 3 种截骨术相比，Mitchell 截骨术的平均术后 HVA 明显更高。在任何 2 项或更多研究报告的手术技术中，使用 3 个 HVA 阈值或跖骨间角，复发率没有显著差异。考虑到 HVA 的各种阈值，汇总的 HV 复发率如下：>15 度的为 64%，>20 度的为 10%，>25 度的为 5%。所有手术类别的长期复发率表明，在修改或引入新的手术技术之前，需要更好地了解 HV 的发病机制和预后。
IV 级，荟萃分析。
