开放与微创远端跖骨截骨术治疗拇外翻的影像学比较。
Radiographic Comparison of Open and Minimally Invasive Distal Chevron Metatarsal Osteotomy in Patients With Hallux Valgus.
机构信息
Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi, Korea.
Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi, Korea.
出版信息
J Foot Ankle Surg. 2024 May-Jun;63(3):386-391. doi: 10.1053/j.jfas.2024.01.012. Epub 2024 Jan 26.
This study aimed to compare radiographic outcomes of open and minimally invasive surgery (MIS) in patients with hallux valgus. We reviewed data of patients with hallux valgus who underwent open or minimally invasive distal chevron osteotomy at our institution. Radiographic assessment was completed preoperatively, immediate postoperatively, and one year postoperatively using eight weight bearing parameters . The classic distal chevron osteotomy method was used for open surgery and a modified method that added percutaneous K-wire fixation to the minimal invasive Chevron-Akin (third-generation MIS) was used for correction of the distal metatarsal articular angle (DMAA). A total of 65 feet (33 open surgeries and 32 MIS) were included. The HVA, IMA, and DMAA improved significantly following surgery regardless of surgical method (p<0.001). Other radiographic indicators showed no statistically significant differences after surgery. DMAA improved by 71.0±14.2% after surgery, and the open surgery group showed less significant reduction in DMAA (49.7±25.7%, p<0.001). Other parameters showed no difference between the two groups regarding relative postoperative changes. The MIS group showed shorter operation time (p<0.001) and hospitalization period (p=0.034) than did the open surgery group. Therefore, the MIS group is expected to be cost-effective. Radiographic measurements revealed comparable outcomes of MIS compared with open surgery. Additionally, adding percutaneous K-wire fixation during MIS had an advantage in correcting DMAA compared with open surgery. Furthermore, the correction of DMAA could reduce recurrence of valgus deformity of the hallux.
本研究旨在比较拇外翻患者开放手术和微创手术(MIS)的影像学结果。我们回顾了在我院接受开放或微创远端跖骨截骨术的拇外翻患者的数据。术前、术后即刻和术后 1 年采用 8 项负重参数进行影像学评估。经典的开放手术采用远端跖骨 Chevron 截骨术,改良的微创 Chevron-Akin(第三代 MIS)方法采用经皮 K 线固定以矫正远端跖骨关节角(DMAA)。共纳入 65 足(33 例开放手术和 32 例 MIS)。无论手术方法如何,HVA、IMA 和 DMAA 在手术后均显著改善(p<0.001)。其他影像学指标术后无统计学差异。手术后 DMAA 改善了 71.0±14.2%,而开放手术组 DMAA 的减少幅度较小(49.7±25.7%,p<0.001)。两组在术后相对变化方面,其他参数无差异。MIS 组的手术时间(p<0.001)和住院时间(p=0.034)均短于开放手术组。因此,MIS 组有望具有成本效益。影像学测量显示,MIS 与开放手术的结果相当。此外,与开放手术相比,在 MIS 中添加经皮 K 线固定在矫正 DMAA 方面具有优势。此外,DMAA 的矫正可以降低拇外翻畸形的复发率。