Lewis Thomas L, Barakat Ahmed, Mangwani Jitendra, Ramasamy Arul, Ray Robbie
King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK.
Academic Team of Musculoskeletal Surgery, Leicester Orthopaedics, University Hospitals of Leicester, Leicester, UK.
Bone Joint J. 2025 Jan 1;107-B(1):10-18. doi: 10.1302/0301-620X.107B1.BJJ-2024-0597.R2.
Hallux valgus (HV) presents as a common forefoot deformity that causes problems with pain, mobility, footwear, and quality of life. The most common open correction used in the UK is the Scarf and Akin osteotomy, which has good clinical and radiological outcomes and high levels of patient satisfaction when used to treat a varying degrees of deformity. However, there are concerns regarding recurrence rates and long-term outcomes. Minimally invasive or percutaneous surgery (MIS) has gained popularity, offering the potential for similar clinical and radiological outcomes with reduced postoperative pain and smaller scars. Despite this, MIS techniques vary widely, hindering comparison and standardization. This review evaluates the evidence for both open Scarf and Akin osteotomy and newer-generation MIS techniques. Fourth-generation MIS emphasizes multiplanar rotational deformity correction through stable fixation. While MIS techniques show promise, their evidence mainly comprises single-surgeon case series. Comparative studies between open and MIS techniques suggest similar clinical and radiological outcomes, although MIS may offer advantages in scar length and less early postoperative pain. MIS may afford superior correction in severe deformity and lower recurrence rates due to correcting the bony deformity rather than soft-tissue correction. Recurrence remains a challenge in HV surgery, necessitating long-term follow-up and standardized outcome measures for assessment. Any comparison between the techniques requires comparative studies. Surgeons must weigh the advantages and risks of both open and MIS approaches in collaboration with patients to determine the most suitable treatment.
拇外翻（HV）是一种常见的前足畸形，会引发疼痛、活动受限、鞋类适配问题以及生活质量下降等问题。英国最常用的开放性矫正手术是Scarf截骨术和Akin截骨术，用于治疗不同程度的畸形时，具有良好的临床和影像学效果，患者满意度较高。然而，人们对复发率和长期疗效存在担忧。微创或经皮手术（MIS）越来越受欢迎，有望实现类似的临床和影像学效果，同时减少术后疼痛并缩小疤痕。尽管如此，MIS技术差异很大，阻碍了比较和标准化。本综述评估了开放性Scarf截骨术和Akin截骨术以及新一代MIS技术的证据。第四代MIS强调通过稳定固定进行多平面旋转畸形矫正。虽然MIS技术前景广阔，但其证据主要包括单术者病例系列。开放性手术和MIS技术之间的比较研究表明，两者临床和影像学效果相似，不过MIS在疤痕长度和术后早期疼痛方面可能具有优势。由于矫正的是骨畸形而非软组织畸形，MIS在严重畸形矫正方面可能更具优势，复发率更低。复发仍然是HV手术面临的挑战，需要长期随访和标准化的疗效评估指标。两种技术之间的任何比较都需要进行对照研究。外科医生必须与患者合作，权衡开放性手术和MIS手术的利弊，以确定最合适的治疗方法。
