Abstract：
BACKGROUND: Hallux valgus (HV) is a very common deformity worldwide. Most of the surgical techniques used in the treatment of HV only correct these deformities in two planes, that is sagittal and transverse planes. The importance of the first metatarsal pronation as an etiological factor of hallux valgus is validated by numerous authors and it is usually unaddressed. Few surgical techniques have focused on the correction of rotational deformity of the hallux valgus. We aim to first report a detailed technique and a case series using the Distal Rotational Metatarsal Osteotomy (DROMO) surgical technique, which is less invasive and can address the pronation deformation.
METHODS: The inclusion period was 6 months finishing in April 2021. The study analyzed the following x-ray parameters: preoperative and postoperative intermetatarsal angle (IMA), preoperative and postoperative hallux valgus angle (HVA), preoperative and postoperative coronal rotation of the first metatarsal according Hardy and Clapham\'s classification as described by Kim et al., preoperative and postoperative shape of the first metatarsal head as described by Ono et al. RESULTS: 33 patients matched our inclusion and exclusion criteria. Most patients underwent the surgery for the left foot (n = 18), compared to the right foot (n = 15). We found statistically significant differences between preoperative and postoperative IMA (p < 0.001), preoperative and postoperative HVA (p < 0.001). Preoperative and postoperative coronal rotation of the first metatarsal as classified by Hardy and Clapham was significantly different (p < 0.001), as well as preoperative and postoperative shape of the first metatarsal head (p < 0.01).
CONCLUSIONS: DROMO can correct the metatarsal rotation through minimal invasive surgery. From our perspective, DROMO technique should be another alternative for HV correction technique which in time can be associated as a local anesthetic technique, DROMO results are attractive for an ambulatory procedure.
METHODS: The inclusion period was 6 months finishing in April 2021. The study analyzed the following x-ray parameters: preoperative and postoperative intermetatarsal angle (IMA), preoperative and postoperative hallux valgus angle (HVA), preoperative and postoperative coronal rotation of the first metatarsal according Hardy and Clapham\'s classification as described by Kim et al., preoperative and postoperative shape of the first metatarsal head as described by Ono et al. RESULTS: 33 patients matched our inclusion and exclusion criteria. Most patients underwent the surgery for the left foot (n = 18), compared to the right foot (n = 15). We found statistically significant differences between preoperative and postoperative IMA (p < 0.001), preoperative and postoperative HVA (p < 0.001). Preoperative and postoperative coronal rotation of the first metatarsal as classified by Hardy and Clapham was significantly different (p < 0.001), as well as preoperative and postoperative shape of the first metatarsal head (p < 0.01).
CONCLUSIONS: DROMO can correct the metatarsal rotation through minimal invasive surgery. From our perspective, DROMO technique should be another alternative for HV correction technique which in time can be associated as a local anesthetic technique, DROMO results are attractive for an ambulatory procedure.
摘要：
背景：Hallux外翻（HV）是世界范围内非常常见的畸形。大多数用于治疗HV的手术技术仅在两个平面上纠正这些畸形，即矢状和横向平面。第一meta骨前旋作为外翻的病因因素的重要性已被许多作者证实，并且通常没有得到解决。很少有手术技术专注于矫正外翻的旋转畸形。我们的目标是首先报告使用远端旋转跖骨截骨术（DROMO）手术技术的详细技术和病例系列，侵入性较小，可以解决内旋变形。
方法：纳入期为6个月，于2021年4月结束。该研究分析了以下X射线参数：术前和术后的meta骨间角（IMA），术前和术后的外翻角（HVA），根据Kim等人描述的Hardy和Clapham分类，术前和术后第一跖骨冠状旋转。,如Ono等人所述，第一跖骨头的术前和术后形状。结果：33例患者符合我们的纳入和排除标准。大多数患者接受了左脚手术（n=18），与右脚相比（n=15）。我们发现术前和术后IMA之间有统计学意义的差异（p<0.001），术前和术后HVA（p<0.001）。根据Hardy和Clapham的分类，第一跖骨的术前和术后冠状旋转存在显着差异（p<0.001），术前、术后第一跖骨头的形态(p<0.01)。
结论：DROMO可以通过微创手术矫正跖骨旋转。从我们的角度来看,DROMO技术应该是HV矫正技术的另一种替代方法，该技术在时间上可以作为局部麻醉技术。DROMO结果对于门诊程序具有吸引力。
方法：纳入期为6个月，于2021年4月结束。该研究分析了以下X射线参数：术前和术后的meta骨间角（IMA），术前和术后的外翻角（HVA），根据Kim等人描述的Hardy和Clapham分类，术前和术后第一跖骨冠状旋转。,如Ono等人所述，第一跖骨头的术前和术后形状。结果：33例患者符合我们的纳入和排除标准。大多数患者接受了左脚手术（n=18），与右脚相比（n=15）。我们发现术前和术后IMA之间有统计学意义的差异（p<0.001），术前和术后HVA（p<0.001）。根据Hardy和Clapham的分类，第一跖骨的术前和术后冠状旋转存在显着差异（p<0.001），术前、术后第一跖骨头的形态(p<0.01)。
结论：DROMO可以通过微创手术矫正跖骨旋转。从我们的角度来看,DROMO技术应该是HV矫正技术的另一种替代方法，该技术在时间上可以作为局部麻醉技术。DROMO结果对于门诊程序具有吸引力。
