Jarde O, Trinquier J L, Mertl P, Filloux J F, Vives P
Service d'Orthopédie traumatologie, Hôpital Nord, Amiens.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(2):136-41.
49 cases of hallux-valgus were treated by a shortening of the phalanx with impaction according to the technic described by Regnauld, associated with a plasty of the adductor. Patients were evaluated with a follow-up greater than 5 years.
32 female and 5 male patients were treated. 63 per cent patients were between 30 and 60 years old. The preoperative average of metatarsus varus was 12 degrees 1. The length of first metatarsal was inferior to the second in 30 cases. The preoperative average of first phalange valgus was 30 degrees. Every operated foot had an Egyptian morphotype. Sesamoids were consistently dislocated. Associated lesion were: 19 flat feet, 10 round fore-feet, 9 clinodactylies treated during the same procedure.
They were evaluated according 3 Groulier's criteria: the correction of deformation, static disturbances, and professional activities. The phalangeal valgus was corrected in 37 cases (72 per cent). 33 feet were painless (67 per cent). The dorsal flexion of the first toe was superior to 60 degrees in 38 cases (77 per cent). Metatarsus varus was consistently reduced. 2 permanent metatarsalgia and 4 plantar corns persisted. 76 per cent of operated patients were able to wear shoes normally with a normal perimeter of walking. At X-ray examination, the head of first metatarsal was unchanged in all cases. The joint space was normal in 39 cases (79 per cent). The base of first phalanx was normal in 25 cases (51 per cent). 37 feet had centered sesamoïds. In total, we noticed: 37 very good and good results (72 per cent), 8 moderate results (17 per cent), bad results (9 per cent).
The operative technic gives a stable shortening of the first phalanx without material and allows the early weight bearing. The abductor of the great toe is a stronger muscle than adductor, allows rotational correction and the alignment of the first phalanx on the first metatarsal. We agree with criteria of bad prognosis proposed by Groulier: age, valgus flat foot, the duration and the importance of deformation, the presence of osteoarthritis.
The abductor plasty and soft tissue operation contributes to the durable correction of hallux valgus. Shortening must preserve the vascularization of the proximal end of the phalangeal. This operation should be reserved for young patients, without signs of articular cartilage degeneration and having an Egyptian foot.
根据雷尼奥尔德描述的技术，对49例拇外翻患者进行了嵌压式趾骨缩短术，并联合内收肌成形术。对患者进行了超过5年的随访评估。
治疗了32例女性和5例男性患者。63%的患者年龄在30至60岁之间。术前第一跖骨内翻平均为12度1。30例患者第一跖骨长度短于第二跖骨。术前第一趾骨外翻平均为30度。每只接受手术的足均为埃及足型。籽骨均有脱位。相关病变包括：19例扁平足，10例圆形前足，9例在同一手术过程中治疗的小指畸形。
根据格鲁利耶的三项标准对患者进行评估：畸形矫正、静态干扰和职业活动。37例（72%）患者的趾骨外翻得到矫正。33只足无痛（67%）。38例（77%）患者第一趾背屈超过60度。第一跖骨内翻持续减轻。2例出现永久性跖痛症，4例足底鸡眼持续存在。76%的手术患者能够正常穿鞋，行走范围正常。X线检查显示，所有病例中第一跖骨头均无变化。39例（79%）患者关节间隙正常。25例（51%）患者第一趾骨基部正常。37只足的籽骨复位。总体而言，我们发现：37例效果非常好和良好（72%），8例效果中等（17%），效果差（9%）。
手术技术能使第一趾骨稳定缩短，无需植入材料，并允许早期负重。拇趾外展肌比内收肌更强壮，能实现旋转矫正并使第一趾骨与第一跖骨对齐。我们认同格鲁利耶提出的不良预后标准：年龄、外翻扁平足、畸形的持续时间和严重程度、骨关节炎的存在。
外展肌成形术和软组织手术有助于拇外翻的持久矫正。缩短操作必须保留趾骨近端的血供。该手术应仅适用于年轻患者，无关节软骨退变迹象且为埃及足型。
