大脚趾近节趾骨融合术治疗年轻患者的拇趾近节趾间关节畸形。

Great Toe Interphalangeal Fusion for Hallux Valgus Interphalangeus Deformity in Young Patients.

机构信息

Shriners Hospitals for Children.

University of South Carolina Greenville School of Medicine, Greenville, SC.

出版信息

J Pediatr Orthop. 2024 Mar 1;44(3):179-183. doi: 10.1097/BPO.0000000000002580. Epub 2023 Nov 24.

DOI:10.1097/BPO.0000000000002580

PMID:37997383

Abstract

OBJECTIVES

The purposes of this study were to examine indications, radiographic outcomes, and clinical complications for primary arthrodesis of the great toe interphalangeal (IP) joint in young patients.

BACKGROUND

Hallux valgus interphalangeus deformity of the great toe is uncommon in the pediatric population and often requires fusion of the IP joint.

METHODS

A retrospective review of patients, ages 8 to 19 years, who underwent operative fusion of the great toe IP joint, and had >1 year radiographic follow-up was performed. Medical records and radiographs were reviewed to determine indications for surgery, concomitant procedures, success of fusion, complications, and need for revision procedures or elective hardware removal. Differences between pre and postradiographic outcomes for the hallux valgus angle, IP angle, and intermetatarsal angle were analyzed.

RESULTS

Twenty-seven patients (31 feet) were included in the analyses. The average age at fusion surgery was 14.9 years (SD ± 2.3) with a mean follow-up visit of 35.2 months. The most common indications for fusion of the great toe IP joint were pain and deformity. Kirschner wire fixation was utilized in 7 cases, with the remaining 24 cases fixed with a single retrograde cannulated screw. Fifty-five concomitant toe and foot procedures were performed in 21 feet (68%) to address additional foot and toe deformity. Successful fusion occurred in 30 of 31 toes after the primary fusion. Patient satisfaction with the toe position and diminished pain were high (94.1%). Significant improvement was noted in the measure of the IP angle ( P < 0.001), with minimal clinical change in the hallux valgus angle ( P = 0.24) or the intermetatarsal angle ( P = 0.03).

CONCLUSIONS

Hallux valgus interphalangeus of the great toe was successfully managed with the fusion of the IP joint. Single screw fixation or the use of Kirschner wires led to similar outcomes. Hardware-related issues with the use of screws were the most common adverse outcome. Patients should be made aware of the possible need for hardware removal after fusion utilizing screw fixation.

LEVEL OF EVIDENCE

Level IV-a retrospective case series.

摘要

目的

本研究旨在探讨青少年患者大脚趾近节趾间关节（IP）关节初次融合的适应证、影像学结果和临床并发症。

背景

大脚趾趾间关节外翻畸形在儿科人群中并不常见，通常需要融合 IP 关节。

方法

对接受大脚趾 IP 关节融合术且影像学随访时间超过 1 年的 8 至 19 岁患者进行回顾性病例系列研究。查阅病历和影像学资料，确定手术适应证、合并手术、融合成功率、并发症以及是否需要翻修手术或择期去除内固定。分析术前和术后的拇外翻角、IP 角和跖骨间角的影像学结果。

结果

共纳入 27 例（31 足）患者进行分析。融合手术的平均年龄为 14.9 岁（标准差 ± 2.3），平均随访时间为 35.2 个月。大脚趾 IP 关节融合的最常见适应证是疼痛和畸形。7 例采用克氏针固定，其余 24 例采用单根逆行空心螺钉固定。为了纠正其他足趾和足部畸形，21 足（68%）共实施了 55 例合并的趾和足部手术。31 个脚趾中有 30 个在初次融合后成功融合。患者对脚趾位置和疼痛减轻的满意度很高（94.1%）。IP 角的测量值有显著改善（P < 0.001），而拇外翻角（P = 0.24）或跖骨间角（P = 0.03）的临床变化很小。