Lewis Thomas L, Lam Peter, Alkhalfan Yousif, Ray Robbie
King's Foot and Ankle Unit, King's College NHS Foundation Trust, London, United Kingdom.
Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia.
Foot Ankle Orthop. 2024 Jul 29;9(3):24730114241263095. doi: 10.1177/24730114241263095. eCollection 2024 Jul.
There has been increasing interest in the use of percutaneous or minimally invasive osteotomy techniques for bunionette correction. The aim of this systematic review was to investigate the clinical and radiographic outcomes following percutaneous or minimally invasive surgery for bunionette deformity correction.
A systematic review following PRISMA guidelines was undertaken. All clinical studies published in MEDLINE, Embase, PubMed, and the Cochrane Library Database from inception until December 2023 reporting on the use of percutaneous or minimally invasive osteotomy techniques for bunionette deformity correction were included. The primary outcome was radiographic deformity correction. A meta-analysis of clinical and radiographic outcomes was performed to assess the mean difference following surgery. Risk of bias was assessed using the ROBINS-I tool.
A total of 942 potential studies were identified, of which 18 were included encompassing 714 feet in 580 patients. There were no comparative studies identified. The majority of studies (n = 14/18) used an unfixed distal osteotomy technique. All studies showed a statistically significant improvement in clinical outcomes (American Orthopaedic Foot & Ankle Society ankle-hindfoot score and visual analog scale for pain) and radiologic outcomes (fourth-fifth intermetatarsal angle and fifth metatarsophalangeal angle). Complication rates ranged from 0% to 21.4%. The nonunion rate was 0% to 5.6%. Overall risk of bias was low to moderate. The most common complication was development of a hypertrophic callus that tended to resorb over time without needing further surgical intervention.
The results of this systematic review must be considered in light of the methodologic limitations of the studies analyzed-including additional procedures performed at the same time as the bunionette correction, lack of comparative studies, and heterogeneity of the case series included. Despite these limitations, our review suggests that percutaneous techniques for bunionette deformity correction are generally clinically safe and associated with improvement in radiographic alignment and patient-reported outcome measures.
对于采用经皮或微创截骨技术矫正小趾囊炎畸形，人们的兴趣日益浓厚。本系统评价的目的是研究经皮或微创手术矫正小趾囊炎畸形后的临床和影像学结果。
按照PRISMA指南进行系统评价。纳入自数据库建立至2023年12月在MEDLINE、Embase、PubMed和Cochrane图书馆数据库中发表的所有关于使用经皮或微创截骨技术矫正小趾囊炎畸形的临床研究。主要结局是影像学畸形矫正。对临床和影像学结果进行荟萃分析，以评估术后的平均差异。使用ROBINS-I工具评估偏倚风险。
共识别出942项潜在研究，其中18项被纳入，涵盖580例患者的714只足。未识别出比较研究。大多数研究（n = 14/18）采用未固定的远端截骨技术。所有研究均显示临床结局（美国矫形足踝协会踝后足评分和疼痛视觉模拟量表）和影像学结局（第四、五跖骨间角和第五跖趾关节角）有统计学意义的改善。并发症发生率为0%至21.4%。骨不连发生率为0%至5.6%。总体偏倚风险为低到中度。最常见的并发症是形成肥厚性胼胝，随着时间推移往往会自行吸收，无需进一步手术干预。
鉴于所分析研究的方法学局限性，包括与小趾囊炎矫正同时进行的其他手术、缺乏比较研究以及所纳入病例系列的异质性，必须考虑本系统评价的结果。尽管存在这些局限性，但我们的评价表明，经皮技术矫正小趾囊炎畸形通常在临床上是安全的，并且与影像学对线改善和患者报告的结局指标相关。
