Hong Kong Adventist Hospital, Hong Kong, SAR, China.
Department of Statistics & Actuarial Science, University of Hong Kong, Hong Kong, China.
J Foot Ankle Surg. 2024 Mar-Apr;63(2):262-266. doi: 10.1053/j.jfas.2023.11.014. Epub 2023 Dec 5.
Hallux valgus (HV) is a common deformity of the foot. Its postoperative recurrence is not uncommon and is closely related to the recurrence of its underlying metatarsus primus varus (MPV) deformity. The syndesmosis procedure uses 1 to 2 intermetatarsal cerclage sutures to realign the first metatarsal and then induces a biological bonding between the 2 metatarsals to prevent the MPV deformity from recurring. This radiological study aimed to assess its effectiveness in long-term MPV and HV deformities recurrence prevention. Ninety-two feet of 51 consecutive patients had syndesmosis procedures that were prospectively followed up for more than 1 y and up to 14 y, averaging 100.5 (SD 45.2) months. Patients underwent X-ray examinations regularly at fixed intervals of their feet. We used Hardy's methods in measuring the intermetatarsal angle (IMA), hallux valgus angle (HVA), and medial sesamoid position from standing foot X-rays. More than 450 relevant X-ray and photo images were submitted as Supplementary Material for online viewing and reference. There was a significant final correction of IMA from 14.30° (SD 2.70) to 6.70° (SD 1.75) (p < .0001). There was no significant increase in IMA after the sixth postoperative month to their final follow-up endpoints, regardless of their lengths. There was a significant final correction of HVA from 31.95° (SD 7.45) to 19.1° (SD 7.45) (p < .0001). This study reconfirmed past findings that the MPV deformity could be corrected without osteotomies. Creating a syndesmosis-like intermetatarsal bonding was effective for long-term MPV recurrence prevention. Three feet had postoperative stress fracture of the second metatarsal. However, the HV deformity correction was less satisfactory, and the reasons were explained.
拇外翻（HV）是一种常见的足部畸形。其术后复发并不少见，且与跖骨首内翻（MPV）畸形的复发密切相关。联合部切开术采用 1 至 2 条跖骨间环形缝线来重新排列第一跖骨，然后在两跖骨之间产生生物结合，以防止 MPV 畸形复发。这项放射学研究旨在评估其在长期预防 MVP 和 HV 畸形复发方面的有效性。51 例连续患者的 92 只脚前瞻性随访超过 1 年，最长随访时间为 14 年，平均随访时间为 100.5（SD 45.2）个月。患者定期在其足部固定间隔接受 X 射线检查。我们使用 Hardy 法从站立足部 X 射线测量跖骨间角（IMA）、拇外翻角（HVA）和内侧籽骨位置。超过 450 张相关 X 射线和照片图像作为补充材料提交，以供在线查看和参考。IMA 从术前的 14.30°（SD 2.70）显著矫正至术后的 6.70°（SD 1.75）（p＜0.0001）。无论术后时间长短，术后第六个月后 IMA 均无明显增加，直至最终随访终点。HVA 从术前的 31.95°（SD 7.45）显著矫正至术后的 19.1°（SD 7.45）（p＜0.0001）。本研究再次证实了过去的发现，即无需截骨即可矫正 MVP 畸形。创建联合部样的跖骨间结合对于长期预防 MVP 复发是有效的。三例患者术后第二跖骨应力性骨折。然而，HV 畸形矫正效果较差，原因已解释。
