Zhanaspayev Amangasy, Bokembayev Nurlan, Zhanaspayev Marat, Tlemissov Aidos, Aubakirova Sabina, Prokazyuk Alexander
Department of Traumatology and Orthopaedics, The National Scientific Center of Traumatology and Orthopaedics Named after Academician Batpenov ND, Astana 010000, Kazakhstan.
Department of Traumatology and Paediatric Surgery, Non-Commercial Joint-Stock Company "Semey Medical University", Semey 071400, Kazakhstan.
World J Orthop. 2024 Mar 18;15(3):238-246. doi: 10.5312/wjo.v15.i3.238.
Hallux valgus (HV) is a common foot deformity that manifests with increasing age, especially in women. The associated foot pain causes impaired gait and decreases quality of life. Moderate and severe HV is a deformity that is characterized by the involvement of lesser rays and requires complex surgical treatment. In this study, we attempted to develop a procedure for this condition.
To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity.
We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor's bunion and metatarsalgia were surgically treated a new method involving surgical correction of all associated problems. This method included a modified Lapidus procedure, M2M3 tarsometatarsal arthrodesis, intermetatarsal fusion of the M4 and M5 bases, and the use of an original external fixation apparatus to enhance correction power. Preoperative, postoperative, and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared, and values < 0.05 were considered to indicate statistical significance.
The study included 28 females (93.3%) and 2 males feet (6.7%), 20 (66.7%) of whom had a moderate degree of HV and 10 (33.3%) of whom had severe deformity. M2 and M3 metatarsalgia was observed in 21 feet, and 9 feet experienced pain only at M2. The mean follow-up duration was 11 months. All patients had good correction of the HV angle [preoperative median, 36.5 degrees, interquartile range (IQR): 30-45; postoperative median, 10 degrees, IQR: 8.8-10; follow-up median, 11.5 degrees, IQR: 10-14; < 0.01]. At follow-up, metatarsalgia was resolved in most patients (30 5). There was a clinically negligible decrease in the corrected angles at the final follow-up, and the overall AOFAS score was significantly better (median, 65 points, IQR: 53.8-70; 80 points, IQR: 75-85; < 0.01).
The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up. Randomized clinical trials with larger samples, as well as long-term outcome assessments, are needed in the future.
拇外翻（HV）是一种常见的足部畸形，随着年龄增长而愈发明显，在女性中尤为常见。相关的足部疼痛会导致步态受损并降低生活质量。中度和重度拇外翻是一种累及小趾列的畸形，需要进行复杂的手术治疗。在本研究中，我们试图开发一种针对这种情况的手术方法。
分析对静态前足畸形所有部位同时进行手术矫正的患者的治疗结果。
我们在2016年至2021年期间进行了一项前瞻性临床试验，对30只患有中度或重度拇外翻并伴有小趾囊炎和跖痛症的足部采用一种新方法进行手术治疗，该方法涉及对所有相关问题进行手术矫正。此方法包括改良的Lapidus手术、M2M3跗跖关节融合术、第4和第5跖骨基底的跖间融合术，以及使用一种原创的外固定装置以增强矫正力。比较术前、术后和最终随访的影像学数据以及美国矫形足踝协会（AOFAS）评分，P值<0.05被认为具有统计学意义。
该研究纳入28名女性（93.3%）和2名男性（6.7%）的足部，其中20只（66.7%）为中度拇外翻，10只（33.3%）为重度畸形。21只足部观察到第2和第3跖骨疼痛，9只足部仅在第2跖骨处疼痛。平均随访时间为11个月。所有患者的拇外翻角度均得到良好矫正[术前中位数，36.5度，四分位间距（IQR）：30 - 45；术后中位数，10度，IQR：8.8 - 10；随访中位数，11.5度，IQR：10 - 14；P<0.01]。随访时，大多数患者（30/30）的跖痛症得到缓解。最终随访时矫正角度有临床上可忽略不计的减小，总体AOFAS评分显著更好（中位数，65分，IQR：53.8 - 70；术前80分，IQR：75 - 85；P<0.01）。
在一年随访中，所开发的方法在一小部分患者样本中显示出良好的矫正力可持续性。未来需要进行更大样本量的随机临床试验以及长期疗效评估。
