Noback Peter C, Trofa David P, Vosseller J Turner
Trauma Training Center, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
Foot Ankle Orthop. 2023 Aug 14;8(3):24730114231195359. doi: 10.1177/24730114231195359. eCollection 2023 Jul.
There is substantial variability in the operative treatment of hallux valgus despite the existence of high quality evidence to guide treatment decisions. The purpose of this study was to determine the current trends in the treatment of mild, moderate, and severe hallux valgus and if greater degrees of consensus correlate with the presence of higher-level evidence.
Members of the American Orthopaedic Foot & Ankle Society completed a 14-item survey. A total of 131 (14%) of 922 members completed the survey. Three cases representing 3 stages of HV were presented, and respondents selected their preferred treatment. Preferred forms of proximal and distal metatarsal osteotomies, as well as mode of fixation for each, were inquired.
In the treatment of mild hallux valgus without second metatarsalgia, 80% of those surveyed chose a distal metatarsal osteotomy, while, if second metatarsalgia was present, 56% chose a distal metatarsal osteotomy with a second metatarsal-shortening osteotomy. In the treatment of moderate hallux valgus, there was generally less consensus, while, in the treatment of severe hallux valgus, a majority of those surveyed chose a Lapidus procedure, with the addition of a second metatarsal-shortening osteotomy in the presence of second metatarsalgia. The most popular distal and proximal metatarsal osteotomies, respectively, were chevron osteotomy (80%) and opening wedge osteotomy (33%). The presence of Level I evidence did not significantly correlate with higher degrees of consensus.
Despite the existence of high-quality evidence supporting the use of certain procedures in the treatment of HV, there exists an apparent lack of consensus among surgeons about the choice of surgical procedures. Moreover, higher-level evidence was not correlated with greater consensus in hallux valgus.
Level II.
尽管有高质量证据可指导治疗决策，但拇外翻的手术治疗仍存在很大差异。本研究的目的是确定轻度、中度和重度拇外翻治疗的当前趋势，以及更高程度的共识是否与更高级别的证据存在相关。
美国足踝外科协会成员完成了一项包含14个项目的调查。922名成员中共有131名（14%）完成了调查。展示了代表拇外翻3个阶段的3个病例，受访者选择他们偏好的治疗方法。询问了跖骨近端和远端截骨术的首选形式以及每种截骨术的固定方式。
在治疗无第二跖骨痛的轻度拇外翻时，80%的受访者选择了远端跖骨截骨术，而如果存在第二跖骨痛，56%的受访者选择了远端跖骨截骨术加第二跖骨缩短截骨术。在治疗中度拇外翻时，共识普遍较少，而在治疗重度拇外翻时，大多数受访者选择了Lapidus手术，若存在第二跖骨痛则加做第二跖骨缩短截骨术。最受欢迎的远端和近端跖骨截骨术分别是V形截骨术（80%）和开放楔形截骨术（33%）。一级证据的存在与更高程度的共识无显著相关性。
尽管有高质量证据支持在拇外翻治疗中使用某些手术方法，但外科医生在手术方法的选择上明显缺乏共识。此外，在拇外翻治疗中，更高级别的证据与更高的共识并无关联。
二级。
