Jahss M H, Troy A I, Kummer F
Foot Ankle. 1985 May-Jun;5(6):280-321. doi: 10.1177/107110078500500602.
The operative effectiveness of five different first metatarsal osteotomies for nonarthritic hallux valgus and metatarsus primus varus were objectively evaluated roentgenographically. The series consisted of 120 feet (75 patients) seen over a 5-year period. The osteotomies were biplanar neck, Chevron, biplanar basilar, basilar concentric, and basilar concentric combined with a lateral closing wedge. All the osteotomies except for the Chevron had varying degrees of plantar displacement of the distal fragment and crossed Kirschner wire fixation. The operative techniques and failures are discussed. Special x-ray studies confirmed misleading pseudocorrections caused by bandage compression and intraoperative and early postoperative roentgenographic distortion. The Chevron gave the least correction, 2 degrees, and did not permit plantar displacement to obviate late metatarsal transfer lesions. The biplanar neck osteotomies were technically the simplest, giving 86% satisfactory corrections, averaging 4.3 degrees. The biplanar basilar osteotomies yielded the most erratic results. The poor results were due to medial tilt during fixation, thereby negating any correction. The technical difficulties with the basilar concentric osteotomy were overcome by the addition of a small lateral closing wedge. This procedure gave by far the most consistently good results with corrections of up to 12 degrees, averaging 7.9 degrees.
通过X线摄影对五种不同的第一跖骨截骨术治疗非关节炎性拇外翻和第一跖骨内翻的手术效果进行了客观评估。该系列包括在5年期间观察的120只足（75例患者）。截骨术包括双平面颈部截骨、契形截骨、双平面基底截骨、基底同心截骨以及基底同心截骨联合外侧闭合楔形截骨。除契形截骨外，所有截骨术的远侧骨折块均有不同程度的跖侧移位，并采用克氏针交叉固定。文中讨论了手术技术及失败原因。特殊的X线研究证实了绷带压迫以及术中及术后早期X线摄影失真所导致的误导性假矫正。契形截骨矫正最少，为2度，且不允许跖侧移位以避免晚期跖骨转移病变。双平面颈部截骨术在技术上最简单，矫正满意率为86%，平均为4.3度。双平面基底截骨术的结果最不稳定。效果不佳是由于固定期间出现内侧倾斜，从而抵消了任何矫正效果。通过增加一个小的外侧闭合楔形截骨克服了基底同心截骨术的技术难题。该手术的矫正效果迄今为止最为稳定，可达12度，平均为7.9度。
