Markbreiter L A, Thompson F M
Hospital for Special Surgery, St. Luke's-Roosevelt Hospital Center, New York, NY 10021, USA.
Foot Ankle Int. 1997 Feb;18(2):71-6. doi: 10.1177/107110079701800205.
We retrospectively evaluated the results of 50 hallux valgus reconstructions in 36 patients for moderate to severe deformities, performed by the senior author (F. M. T.). All feet were treated at the metatarsophalangeal joint with a distal soft tissue realignment. The first 25 feet were corrected proximally with a crescentic osteotomy fixed with an AO screw; these cases had an average follow-up of more than 5 years (range, 40-141 months). The second 25 feet underwent a basal osteotomy with a proximally directed chevron osteotomy; these cases had an average follow-up of 21.4 months (range, 12-33 months). The average hallux valgus correction in the crescentic osteotomy group went from 37.6 degrees to 11.4 degrees, and in the chevron osteotomy group, the hallux valgus angle was reduced from 31.3 degrees to 11.6 degrees. The intermetatarsal angle in the crescentic group was corrected from 16.2 degrees to 6 degrees, and in the chevron group the intermetatarsal angle was reduced from 15.1 degrees to 5.4 degrees. The fibular sesamoid subluxation was reduced from 92% to 24% in the crescentic group and from 88% to 18% in the chevron group. All patients were assessed using the American Orthopaedic Foot and Ankle Society scale, in which 100 points are used to compare pre- and postoperative pain, function and range of motion, shoewear comfort and activity levels, and alignment. In the crescentic group, the score improved from 46.8 points to 93.1 points; in the chevron group, the score changed from 53.4 points to 92.7 points. In all parameters studied, there were no statistically significant differences using the Student's t-test. We conclude that the two operative techniques offer equivalent results, which are excellent and predictable. The proximal chevron osteotomy is technically easier, eliminates the proximal dorsal scar, and does not require postoperative metal removal.
我们回顾性评估了资深作者（F.M.T.）为36例中重度拇外翻畸形患者进行的50例拇外翻重建手术的结果。所有足部均在跖趾关节处采用远端软组织重新排列进行治疗。前25只足采用AO螺钉固定的新月形截骨术进行近端矫正；这些病例的平均随访时间超过5年（范围为40 - 141个月）。后25只足采用近端定向的V形截骨术进行基底截骨；这些病例的平均随访时间为21.4个月（范围为12 - 33个月）。新月形截骨术组的平均拇外翻矫正角度从37.6度降至11.4度，V形截骨术组的拇外翻角度从31.3度降至11.6度。新月形组的跖间角从16.2度矫正至6度，V形组的跖间角从15.1度降至5.4度。新月形组腓侧籽骨半脱位从92%降至24%，V形组从88%降至18%。所有患者均使用美国矫形足踝协会量表进行评估，该量表用100分来比较术前和术后的疼痛、功能和活动范围、鞋类舒适度和活动水平以及对线情况。新月形组的评分从46.8分提高到93.1分；V形组的评分从53.4分变为92.7分。在所有研究参数中，使用学生t检验无统计学显著差异。我们得出结论，这两种手术技术提供了等效的结果，效果极佳且可预测。近端V形截骨术在技术上更简单，消除了近端背侧瘢痕，且无需术后取出金属内固定物。
