Dovetailed Notch Scarf 截骨术矫正中重度拇外翻畸形第一跖骨内翻的放射学和临床疗效：一项对比研究。

Radiologic and Clinical Outcomes of the Dovetailed Notch Scarf Osteotomy for Correcting the First Metatarsal Pronation in Moderate to Severe Hallux Valgus Deformity: A Comparative Study.

机构信息

Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, China.

出版信息

Foot Ankle Int. 2024 Jul;45(7):728-736. doi: 10.1177/10711007241238226. Epub 2024 Apr 18.

DOI:10.1177/10711007241238226

PMID:38634422

Abstract

BACKGROUND

The traditional scarf osteotomy (TSO) has limited ability to correct the first metatarsal pronation. A novel modification that we refer to as a "dovetailed notch scarf osteotomy" (DNSO) has been developed to enhance the ability to correct coronal plane pronation. The study aimed to observe and compare TSO to DNSO in the treatment of moderate to severe hallux valgus deformity.

METHODS

This retrospective study included 78 feet that had a TSO and 105 feet that had a DNSO. Minimum follow-up was 24 months. Weightbearing computed tomography (WBCT) and weightbearing anterior-posterior (AP) radiographs were taken preoperatively and at the last follow-up. We measured the intermetatarsal angle (IMA), hallux valgus angle, distal metatarsal articular surface angle on AP radiographs and first metatarsal coronal pronation angle (α angle), tibial sesamoid coronal grading, and first metatarsal length on WBCT. Clinical assessment was done using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, Foot and Ankle Ability Measure (FAAM), and the 36-Item Short Form Health Survey (SF-36). The occurrence of postoperative complications was also documented.

RESULTS

The DNSO group exhibited a significantly higher correction amount of α angle and IMA (14.3 ± 9.9 and 10.3 ± 4.6 degrees) than the TSO group (8.6 ± 5.9 and 5.4 ± 5.9 degrees) during the final follow-up assessment ( < .05).The DNSO group (10.1 [8.0-12.0] degrees and 4.8 [3.9-5.6] degrees) demonstrated significantly smaller α angle and IMA compared with the TSO group (4.8 [3.9-5.6] degrees and 9.5 [7.5-11.5] degrees) at 24 months postsurgery ( < .05). The postoperative FAAM activities of daily living and SF-36 physical functioning scores were significantly higher in the DNSO group (97.2 ± 3.3 and 95.7 ± 4.4 points) compared with the TSO group (92.3 ± 3.3 and 87.7 ± 8.7 points) ( < .05). Additionally, hallux varus occurred in 1 case in the DNSO group, whereas 4 cases were observed in the TSO group.

CONCLUSION

Two osteotomy methods can effectively correct moderate to severe hallux valgus deformity. Compared with the TSO, the DNSO has stronger correction ability. The most crucial aspect lies in its controllability when correcting first metatarsal pronation and addressing IMA.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

摘要

背景

传统的 Scarf 截骨术（TSO）纠正第一跖骨旋前的能力有限。我们开发了一种新的改良方法，称为“鸠尾切迹 Scarf 截骨术”（DNSO），以增强纠正冠状面旋前的能力。本研究旨在观察并比较 TSO 与 DNSO 治疗中重度拇外翻畸形的效果。

方法

本回顾性研究纳入了 78 例接受 TSO 和 105 例接受 DNSO 的患者。最低随访时间为 24 个月。术前和末次随访时均行负重位 CT（WBCT）和负重位前后位（AP）X 线片检查。我们测量了跖骨间角（IMA）、拇外翻角、AP 位远端跖骨关节面角以及第一跖骨冠状面旋前角（α 角）、胫骨籽骨冠状分级和 WBCT 上的第一跖骨长度。临床评估采用视觉模拟评分（VAS）、美国矫形足踝协会（AOFAS）踝后足评分、足踝能力测量（FAAM）和 36 项简短健康调查（SF-36）进行。还记录了术后并发症的发生情况。

结果

末次随访时，DNSO 组的 α 角和 IMA 的矫正量（14.3±9.9 和 10.3±4.6 度）明显高于 TSO 组（8.6±5.9 和 5.4±5.9 度）（ < .05）。术后 24 个月时，DNSO 组（10.1[8.0-12.0]度和 4.8[3.9-5.6]度）的 α 角和 IMA 明显小于 TSO 组（4.8[3.9-5.6]度和 9.5[7.5-11.5]度）（ < .05）。与 TSO 组相比，DNSO 组术后 FAAM 日常生活活动和 SF-36 躯体功能评分（97.2±3.3 和 95.7±4.4 分）明显更高（92.3±3.3 和 87.7±8.7 分）（ < .05）。此外，DNSO 组发生 1 例踇趾内翻，TSO 组发生 4 例。