■传统的围巾截骨术(TSO)矫正第一跖骨旋前的能力有限。已开发出一种新颖的修饰,我们称之为“燕尾凹口围巾截骨术”(DNSO),以增强纠正冠状平面内旋的能力。本研究旨在观察并比较TSO与DNSO治疗中重度外翻畸形的疗效。
■这项回顾性研究包括78英尺的TSO和105英尺的DNSO。最短随访时间为24个月。术前和最后一次随访时拍摄了称重计算机断层扫描(WBCT)和称重前后(AP)X光片。我们测量了meta骨间角(IMA),外翻角度,APX线照片上的远端meta关节面角和第一meta冠状旋前角(α角),胫骨籽骨冠状分级,WBCT上的第一跖骨长度。使用视觉模拟量表(VAS)进行临床评估,美国骨科足踝协会(AOFAS)踝足-后足量表,脚和脚踝能力测量(FAAM),和36项简式健康调查(SF-36)。还记录了术后并发症的发生。
■在最终随访评估中,DNSO组的α角和IMA的校正量(14.3±9.9和10.3±4.6度)明显高于TSO组(8.6±5.9和5.4±5.9度)(P<.05)。与TSO组(4.8[3.9-5.6]度和9.5[7.5-11.5]度)相比,DNSO组(10.1[8.0-12.0]度和4.8[3.9-5.6]度)在术后24个月表现出明显更小的α角和IMA(P<0.05)。与TSO组(92.3±3.3和87.7±8.7分)相比,DNSO组术后FAAM日常生活活动能力和SF-36躯体功能评分明显增高(97.2±3.3和95.7±4.4分)(P<0.05)。此外,DNSO组有1例患者出现拇指内翻,TSO组4例。
■两种截骨方法均可有效纠正中重度外翻畸形。与TSO相比,DNSO具有较强的校正能力。最关键的方面在于其在矫正第一meta骨前旋和解决IMA时的可控性。
■三级,回顾性比较研究。
UNASSIGNED: The traditional scarf osteotomy (TSO) has limited ability to correct the first metatarsal
pronation. A novel modification that we refer to as a \"dovetailed notch scarf osteotomy\" (DNSO) has been developed to enhance the ability to correct coronal plane
pronation. The
study aimed to observe and compare TSO to DNSO in the treatment of moderate to severe hallux valgus deformity.
UNASSIGNED: This retrospective
study included 78 feet that had a TSO and 105 feet that had a DNSO. Minimum follow-up was 24 months. Weightbearing computed tomography (WBCT) and weightbearing anterior-posterior (AP) radiographs were taken preoperatively and at the last follow-up. We measured the intermetatarsal angle (IMA), hallux valgus angle, distal metatarsal articular surface angle on AP radiographs and first metatarsal coronal pronation angle (α angle), tibial sesamoid coronal grading, and first metatarsal length on WBCT. Clinical assessment was done using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, Foot and Ankle Ability Measure (FAAM), and the 36-Item Short Form Health Survey (SF-36). The occurrence of postoperative complications was also documented.
UNASSIGNED: The DNSO group exhibited a significantly higher correction amount of α angle and IMA (14.3 ± 9.9 and 10.3 ± 4.6 degrees) than the TSO group (8.6 ± 5.9 and 5.4 ± 5.9 degrees) during the final follow-up assessment (P < .05).The DNSO group (10.1 [8.0-12.0] degrees and 4.8 [3.9-5.6] degrees) demonstrated significantly smaller α angle and IMA compared with the TSO group (4.8 [3.9-5.6] degrees and 9.5 [7.5-11.5] degrees) at 24 months postsurgery (P < .05). The postoperative FAAM activities of daily living and SF-36 physical functioning scores were significantly higher in the DNSO group (97.2 ± 3.3 and 95.7 ± 4.4 points) compared with the TSO group (92.3 ± 3.3 and 87.7 ± 8.7 points) (P < .05). Additionally, hallux varus occurred in 1 case in the DNSO group, whereas 4 cases were observed in the TSO group.
UNASSIGNED: Two osteotomy methods can effectively correct moderate to severe hallux valgus deformity. Compared with the TSO, the DNSO has stronger correction ability. The most crucial aspect lies in its controllability when correcting first metatarsal pronation and addressing IMA.
UNASSIGNED: Level III, retrospective comparative
study.