Klobučar Hrvoje, Strahonja Borna, Tršek Denis
Akromion, Special Hospital for Orthopaedic Surgery, Krapinske Toplice, Croatia.
Acta Clin Croat. 2023 Aug;62(Suppl3):60-70. doi: 10.20471/acc.2023.62.s3.8.
The paper elaborates on scarf osteotomy in the treatment of hallux valgus deformity. The study evaluates 175 isolated scarf osteotomies of the first metatarsal (with/without the Akin procedure) performed by one surgeon. Radiological (intermetatarsal angle-IMA, hallux valgus angle-HVA, distal-metatarsal articular angle-DMAA, proximal-to-distal phalangeal-articular angle-PDPAA, translation of diaphysis and sesamoid position) and clinical (Foot and Ankle Disability Index - FADI and the American Orthopedic Foot and Ankle Score - AOFAS) evaluation was done before and after treatment. The follow-up was from 1 to 10 years. HVA decreased 24°, from 32°±8,8(16°-60°) to 8°±7,4(-27°-32°), IMA decreased 11°, from 15°±3,7(16°-31°) to 4°±2,4(0°-13°), DMAA for 12°-from 17° to 5°, PDPAA for 5°-from 5° to 0° and sesamoid position from 5(2-7) to 1(1-7). The first metatarsal translation was 58%±14,5(17%-94%). FADI enlarged from 65±18.2(26-99) to 95±9,7(45-100) and AOFAS from 76±9,to 6(47-98) 96±6,9(72-100). All diferences were significant (p<0,05). Recurrence was 4,6%, iatrogenic hallux varus 6,3%, symptomatic screw 9%, transfer metatarsalgia 2,3%, troughing 2,9% superficial wound infection 1,1%, and postoperative hypesthesia 1,1%. Scarf osteotomy is a reliable and safe procedure for the correction of moderate to severe hallux valgus deformities. A relatively long learning curve is a burden with solvable complications.
本文详细阐述了斜行截骨术治疗拇外翻畸形。该研究评估了由一名外科医生实施的175例单独的第一跖骨斜行截骨术（伴/不伴Akin手术）。在治疗前后进行了放射学评估（跖间角-IMA、拇外翻角-HVA、第一跖骨远端关节角-DMAA、近节趾骨与远节趾骨关节角-PDPAA、骨干移位及籽骨位置）和临床评估（足踝残疾指数-FADI及美国矫形足踝协会评分-AOFAS）。随访时间为1至10年。HVA从32°±8.8（16°-60°）降至8°±7.4（-27°-32°），降低了24°；IMA从15°±3.7（16°-31°）降至4°±2.4（0°-13°），降低了11°；DMAA从17°降至5°，降低了12°；PDPAA从5°降至0°，降低了5°；籽骨位置从5（2-7）降至1（1-7）。第一跖骨移位为58%±14.5（17%-94%）。FADI从65±18.2（26-99）增至95±9.7（45-100），AOFAS从76±9.6（47-98）增至96±6.9（72-100）。所有差异均具有统计学意义（p<0.05）。复发率为4.6%，医源性拇内翻为6.3%，症状性螺钉为9%，转移性跖骨痛为2.3%，骨槽形成2.9%，浅表伤口感染1.1%，术后感觉减退1.1%。斜行截骨术是矫正中重度拇外翻畸形的可靠且安全的手术方法。相对较长的学习曲线是一个负担，但并发症是可解决的。
