使用缝线带增强内侧副韧带可降低重度拇外翻矫正手术后的复发率。
Augmentation of the medial collateral ligament using suture tape reduces the recurrence after corrective surgery for severe hallux valgus.
机构信息
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan.
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan.
出版信息
J Orthop Sci. 2024 Jul;29(4):1046-1053. doi: 10.1016/j.jos.2023.07.010. Epub 2023 Jul 29.
BACKGROUND
The severity of hallux valgus (HV) deformity is associated with recurrence after corrective surgery because of the degenerative change of the medial capsule including the medial collateral ligament (MCL) at the metatarsophalangeal joint. This study aimed to assess the effectiveness of the MCL augmentation using a suture tape anchor of the recurrence of HV and to evaluate the histological changes of the medial joint capsule in HV patients.
METHODS
Thirty-four feet with severe hallux valgus were included and divided into 2 groups. Seventeen feet had the MCL reconstruction using suture tape anchor with a combination of the corrective osteotomy as the suture tape group (mean age, 64.0 years), and other seventeen feet had the corrective osteotomy without MCL reconstruction as the control group (mean age, 62.0 years). HV angle (HVA) and intermetatarsal angle (IMA) on the weight-bearing radiograms and the Japanese Society for Surgery of the Foot (JSSF) score in both groups were compared at the final follow-up. The medial capsule was harvested from other 20 feet with HV and the relationship between the severity of HV and the histological findings was analyzed.
RESULTS
HVA, IMA, and JSSF scores in both groups were significantly improved from preoperatively to the final follow-up (P < 0.01). At the final follow-up, HVA in the suture tape group (9.2°) was significantly smaller than that in the control (15.4°) (P < 0.01). There were no significant differences in the IMA and the JSSF score at the final follow-up between both groups. Histological scores in HV with ≥40° HVA was significantly worse than those in <40°.
CONCLUSION
The medial joint capsule in severe HV deformity showed the degenerative change and the MCL reconstruction using suture tape combined with osteotomy provides a strong medial constraint to prevent the recurrence of the deformity in severe hallux valgus.
LEVEL OF CLINICAL EVIDENCE
背景
拇外翻（HV）畸形的严重程度与矫正手术后的复发有关，因为跖趾关节处的内侧囊包括内侧副韧带（MCL）发生退行性改变。本研究旨在评估使用缝线锚钉增强 MCL 对 HV 复发的效果，并评估 HV 患者内侧关节囊的组织学变化。
方法
纳入 34 例严重拇外翻足，分为 2 组。17 例采用缝线锚钉 MCL 重建联合矫正性截骨术（缝线组，平均年龄 64.0 岁），17 例采用单纯矫正性截骨术（对照组，平均年龄 62.0 岁）。比较两组负重位 X 线片上的 HV 角（HVA）和跖骨间角（IMA），以及日本足外科协会（JSSF）评分。从另外 20 例 HV 患者中获取内侧囊组织，分析 HV 严重程度与组织学发现之间的关系。
结果
两组 HVA、IMA 和 JSSF 评分均从术前显著改善至末次随访（P<0.01）。末次随访时，缝线组 HVA（9.2°）明显小于对照组（15.4°）（P<0.01）。两组末次随访时 IMA 和 JSSF 评分无显著差异。HVA≥40°的 HV 患者的组织学评分明显差于<40°的患者。
结论
严重 HV 畸形的内侧关节囊存在退行性改变，MCL 重建联合截骨术可提供强有力的内侧约束，防止严重拇外翻畸形的复发。
临床证据水平
3。
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