Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano City, Osaka, 586-8521, Japan.
BMC Musculoskelet Disord. 2024 Nov 29;25(1):977. doi: 10.1186/s12891-024-08113-6.
Generally, scarf osteotomy is recommended for moderate-severe hallux valgus (HV) deformity. Although severe HV deformity is defined to be more than 40 degree (°), this definition of angular setting includes broad range of HV angle (HVA). Actually, very severe HV deformity such as more than 60° of the HVA is often seen. At present, whether scarf osteotomy would truly contribute to maintaining the correction status against such very severe deformity is elusive. Then, in this study corrective effectiveness of modified scarf osteotomy including very severe deformity (HVA ≥ 60°) was evaluated.
A retrospective, observational study of 93 feet [mean follow-up: 56.0 months after the surgery] was performed. Hallux scores of the Japanese Society for Surgery of the Foot (JSSF), a self-administered foot evaluation questionnaire (SAFE-Q), and pre-postoperative radiographic parameters were evaluated. The patients were categorized into three groups [44 feet: (mildly severe) 40° ≤ HVA < 50°, 30 feet: (moderately severe) 50° ≤ HVA < 60°, 19 feet: (very severe) HVA ≥ 60°].
Both JSSF hallux and SAFE-Q score showed significant improvement in all groups, except social activity score in SAFE-Q, in very severe cases (P = 0.08). HVA also significantly improved in all groups without significant change of the HVA between post 1-month and final follow-up in each groups. No difference was seen among the three groups in complications after surgery and frequency of recurrence of HV deformity.
Modified scarf osteotomy has sufficient potential to be indicated for very severe (HVA ≥ 60°) deformity, but it might be recommended before the HVA reaches > 60° from the perspective of clinical score improvement.
Level III.
一般来说，对于中重度拇外翻（HV）畸形，建议采用跖骨截骨术。虽然重度 HV 畸形定义为超过 40 度（°），但这个角度设定的定义包括广泛的 HV 角（HVA）范围。实际上，经常会看到非常严重的 HV 畸形，如超过 60°的 HVA。目前，对于这种非常严重的畸形，跖骨截骨术是否真的有助于维持矫正状态还不得而知。因此，本研究评估了改良跖骨截骨术（包括非常严重的畸形，HVA≥60°）的矫正效果。
对 93 例足部（术后平均随访 56.0 个月）进行回顾性、观察性研究。采用日本足外科协会（JSSF）拇趾评分、自我管理足部评估问卷（SAFE-Q）和术前术后影像学参数进行评估。患者分为三组[44 例：（轻度严重）40°≤HVA<50°，30 例：（中度严重）50°≤HVA<60°，19 例：（重度严重）HVA≥60°]。
除了 SAFE-Q 中的社交活动评分外，所有组的 JSSF 拇趾和 SAFE-Q 评分均显著改善，而在非常严重的情况下（P=0.08）。所有组的 HVA 也显著改善，各组在术后 1 个月和最终随访时的 HVA 之间没有显著变化。三组之间在术后并发症和 HV 畸形复发的频率方面没有差异。
改良跖骨截骨术对于非常严重（HVA≥60°）的畸形具有足够的潜力，但从临床评分改善的角度来看，可能建议在 HVA 达到>60°之前使用。
III 级。
