Boden Allison L, DiGiovanni Grace M, Masry Seif El, Ellis Scott J, Johnson A Holly, Conti Matthew S
Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Orthop. 2024 Jul 30;9(3):24730114241266843. doi: 10.1177/24730114241266843. eCollection 2024 Jul.
BACKGROUND: Hallux valgus deformity affects more than 35% of people aged ≥65 years. Surgical correction in this population can be more complicated because of poor bone quality, worse deformity, and postoperative recovery challenges. The purpose of this study was to compare the radiographic and clinical outcomes of patients aged ≥65 years who underwent either open Lapidus or minimally invasive chevron Akin osteotomy for bunion correction. METHODS: A retrospective review identified 62 patients aged ≥65 years who were treated surgically for hallux valgus with at least 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores (physical function and pain interference). Preoperative and at least 6-month postoperative radiographs were measured for the hallux valgus angle and intermetatarsal angle. PROMIS scores were obtained preoperatively and at 1 and/or 2 years postoperatively. Differences in demographic, clinical, and radiographic outcomes were assessed using the Mann Whitney test and values were adjusted for a false discovery rate of 5%. RESULTS: There was no difference between the MIS and open cohorts in pre- or postoperative radiographic measurements or clinical outcomes at any time point. At 1 year postoperatively, both groups had statistically significant improvements in the PROMIS pain interference domain but only the MIS group had a statistically significant improvement in the PROMIS physical function domain. Clinical significance was equivocal. At 2 years postoperatively, there were clinically and statistically significant improvements in the PROMIS pain interference and physical function domains for the open and MIS groups. CONCLUSION: Patients in both surgical groups had improvement in radiographic measurements and 2-year PROMIS scores, although there was no clinical or statistical difference found between groups. MIS and open surgical techniques appear to be safe and effective in correcting hallux valgus in older patients; however, patients may need to be counseled that maximum improvement after surgery may take more than 1 year. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
背景：拇外翻畸形影响超过35%的65岁及以上人群。由于骨质较差、畸形更严重以及术后恢复面临挑战，该人群的手术矫正可能更为复杂。本研究的目的是比较接受开放性Lapidus手术或微创 Chevron Akin截骨术矫正拇囊炎的65岁及以上患者的影像学和临床结果。 方法：一项回顾性研究确定了62例65岁及以上接受拇外翻手术治疗的患者，这些患者术后至少有1年的患者报告结局测量信息系统（PROMIS）评分（身体功能和疼痛干扰）。术前和术后至少6个月的X线片用于测量拇外翻角和跖间角。术前以及术后1年和/或2年获取PROMIS评分。使用Mann Whitney检验评估人口统计学、临床和影像学结果的差异，并对P值进行调整以控制5%的假发现率。 结果：微创组和开放手术组在术前或术后的影像学测量或任何时间点的临床结果方面均无差异。术后1年，两组在PROMIS疼痛干扰领域均有统计学意义的改善，但只有微创组在PROMIS身体功能领域有统计学意义的改善。临床意义不明确。术后2年，开放手术组和微创组在PROMIS疼痛干扰和身体功能领域均有临床和统计学意义的改善。 结论：两个手术组患者的影像学测量和2年PROMIS评分均有改善，尽管两组之间未发现临床或统计学差异。微创和开放手术技术在矫正老年患者拇外翻方面似乎都是安全有效的；然而，可能需要告知患者术后最大改善可能需要1年以上时间。 证据级别：III级，回顾性队列研究。
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