Rezaie Wahid, Fauconnier Sigrid, Faict Sebastian
AZORG, Aalst, Belgium.
Arch Orthop Trauma Surg. 2025 Aug 6;145(1):398. doi: 10.1007/s00402-025-06017-1.
Minimally invasive surgery (MIS) for hallux valgus gained increasing recognition with comparable clinical and radiological outcomes to traditional open surgery. However, there is lack of evidence for safety and efficacy of MIS in the elderly. The aim of this study is to evaluate the surgical and functional outcomes of hallux valgus correction in elderly using screwless MIS technique according to the "triplane osteotomy".
From May 2019 until September 2020 a prospective observational study was set up with patients ≥60 years with symptomatic hallux valgus with an angle (HVA) above 25 degrees or intermetatarsal angle (IMA) above 14 degrees with failure of conservative treatment for at least six months. A single surgeon used a "triplane osteotomy" for the metatarsal, an Akin osteotomy and lateral soft tissue release. A temporary K-wire was used and removed after three weeks. Patients were assessed six weeks, three months and one year postoperatively. Clinical and functional assessment were obtained by the visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) and the Foot Function Index (FFI). Radiographical assessment included the HVA, IMA and DMAA.
37 patients with a mean of 66.05 ± 5.53 years were included. Preoperatively the VAS reduced from 5.19 ± 2.55 to 0.47 ± 0.99, the FFI from 54.00 ± 13.71 to 26.22 ± 7.81, the AOFAS improved from 46.11 ± 13.41 to 83.46 ± 15.91, the HVA from 34.43 ± 8.38 degrees to 7.31 ± 5.55 degrees, the IMA from 13.58 ± 2.55 degrees to 7.48 ± 2.99 degrees and the DMAA from 11.92 ± 5.43 degrees to 7.52 ± 5.19 degrees at one year follow-up. Except for the FFI at six weeks, all functional outcome scores improved significantly compared to preoperatively (P <.001).
Screwless minimally invasive triplane osteotomy provided significant clinical, functional and radiological improvement for the treatment of hallux valgus in patients aged 60 years and older.
Level IV, a prospective observational cohort study.
拇外翻的微创手术（MIS）越来越受到认可，其临床和影像学结果与传统开放手术相当。然而，缺乏MIS在老年人中安全性和有效性的证据。本研究的目的是根据“三平面截骨术”评估使用无螺钉MIS技术矫正老年人拇外翻的手术和功能结果。
从2019年5月至2020年9月，对年龄≥60岁、有症状的拇外翻患者进行了一项前瞻性观察研究，这些患者的拇外翻角（HVA）大于25度或跖间角（IMA）大于14度，且保守治疗失败至少六个月。由一名外科医生对跖骨进行“三平面截骨术”、Akin截骨术和外侧软组织松解术。使用临时克氏针，三周后取出。在术后六周、三个月和一年对患者进行评估。通过视觉模拟量表（VAS）评分、美国矫形足踝协会（AOFAS）和足功能指数（FFI）进行临床和功能评估。影像学评估包括HVA、IMA和DMAA。
纳入37例患者，平均年龄66.05±5.53岁。在一年随访时，VAS评分从术前的5.19±2.55降至0.47±0.99，FFI从54.00±13.71降至26.22±7.81，AOFAS从46.11±13.41提高到83.46±15.91，HVA从34.43±8.38度降至7.31±5.55度，IMA从13.58±2.55度降至7.48±2.99度，DMAA从11.92±5.43度降至7.52±5.19度。除六周时的FFI外，所有功能结局评分与术前相比均有显著改善（P<0.001）。
无螺钉微创三平面截骨术在治疗60岁及以上患者的拇外翻方面提供了显著的临床、功能和影像学改善。
IV级，前瞻性观察队列研究。
