Ospedale Evangelico Internazionale - Salita Superiore, San Rocchino 31/A, 16122, Genova, GE, Italy.
Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli studi di Genova - DISC, Viale Benedetto XV 6, 16132, Genova, GE, Italy.
Int Orthop. 2024 Nov;48(11):2923-2929. doi: 10.1007/s00264-024-06321-2. Epub 2024 Sep 19.
Arthrodesis of the first ray metatarsophalangeal joint (MPJ) is the gold standard in iatrogenic hallux varus (IHV) in the presence of stiffness and osteoarthritis. The purpose of this study is to collect clinical and radiographic results and complications of MPJ arthrodesis in rigid iatrogenic HV.
A retrospective evaluation of rigid iatrogenic HV undergoing arthrodesis with a minimum follow-up (FU) of two years was performed. The clinical parameters assessed were visual analog scale (VAS), the AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score and the satisfaction scale. The radiological parameters evaluated the first to second metatarsal angle (IMA) and the angle of hallux valgus (HVA). Complications were also analysed.
A total of 18 patients (19 procedures) with a mean FU of 5.5 ± 2.5 years were included. The mean VAS improved from 7.3 ± 1.6 to 1.3 ± 1.2 (p < 0.05) at the last FU. Similarly, the AOFAS Hallux Metatarsophalangeal-Interphalangeal scale score significantly improved to 82 ± 9.2 (p < 0.05). Radiological evaluation demonstrated a 1-2 IMA improvement from 4.4 ± 2.2° preoperatively to 8.9 ± 2.4° at 3 months post-operatively. Similarly, there was a significant (p < 0.05) improvement of the HVA from - 22.7 ± 4.1° to 13.1 ± 4.1° at three months post-operative (p < 0.05). No signification loss of correction was noted at the last follow-up (p > 0.05). In one case, a delayed fusion at the arthrodesis site required surgical revision to promote fusion. No patient experienced pain with stress from the first MTP joint arthrodesis site or identified the arthrodesis site as a source of pain. No patient required implant removal. Re-operation and revision rates were 5.3%. The overall complications rate was 15.8%.
MPJ fusion effectively corrects Iatrogenic Hallux Varus in cases of rigid and fixed deformities in the medium- to long-term follow-up, with lasting improvements in AOFAS and VAS scores. The procedure is characterised by a non-negligible risk of complications, reoperations and revisions.
Level IV, case series.
在第一跖趾关节（MPJ）融合术治疗医源性踇外翻（IHV）伴僵硬和骨关节炎中，融合术是金标准。本研究的目的是收集僵硬医源性 HV 行 MPJ 融合术的临床和影像学结果及并发症。
回顾性分析了 18 例（19 处）接受 MPJ 融合术且随访时间至少 2 年的僵硬医源性 HV 患者。评估的临床参数包括视觉模拟评分（VAS）、AOFAS 踇趾-跖趾-趾间关节评分和满意度评分。评估的影像学参数包括第一跖骨与第二跖骨的夹角（IMA）和踇外翻角（HVA）。还分析了并发症。
共纳入 18 例（19 处）患者，平均随访 5.5±2.5 年。末次随访时 VAS 从 7.3±1.6 改善至 1.3±1.2（p<0.05）。同样，AOFAS 踇趾-跖趾-趾间关节评分显著改善至 82±9.2（p<0.05）。影像学评估显示 IMA 从术前的 4.4±2.2°改善至术后 3 个月的 8.9±2.4°。同样，HVA 从术前的-22.7±4.1°显著改善至术后 3 个月的 13.1±4.1°（p<0.05）。末次随访时未见明显矫正丢失（p>0.05）。1 例融合部位延迟愈合，需要手术翻修以促进融合。无患者因第一跖趾关节融合部位疼痛而出现应力，也无患者认为融合部位是疼痛的来源。无患者需要取出植入物。再手术和翻修率为 5.3%。总体并发症发生率为 15.8%。
在中-长期随访中，MPJ 融合术可有效矫正僵硬和固定畸形的医源性踇外翻，AOFAS 和 VAS 评分持续改善。该手术的特点是并发症、再手术和翻修的风险不可忽视。
IV 级，病例系列研究。
