目标:迄今为止,尽管提出了各种方法,但严重外翻畸形的手术治疗仍然具有挑战性。这项研究旨在比较微创远端人字形截骨术(d-MICA)和微创近端人字形截骨术(p-MICA)在纠正严重的外翻畸形中的有效性。
方法:这项前瞻性随访研究包括随机分配接受p-MICA或d-MICA治疗外翻畸形的患者,其术前外翻角度(HVA)≥40°和/或第一至第二跖骨间角(IMA)≥16°。经过至少两年的随访,我们比较了最终随访时HVA超过15°的患者的各种临床影像学参数.
结果:在p-MICA和d-MICA组中,40例中有7例(17.5%),41例中有16例(39.0%),分别,最终随访时HVA>15°(P=0.048)。术前各项参数无明显差异。然而,在第一次负重评估中,HVA,IMA,相对第二跖骨长度明显较小,与d-MICA组相比,p-MICA组的远侧关节角(DMAA)更大(均P<0.05)。术后,两组在末次随访时HVA和IMA均显著下降(所有参数P<0.001).p-MICA组的DMAA和第二跖骨的相对长度没有显着变化(分别为P=0.253和0.185)。然而,d-MICA组的DMAA显著降低(P<0.001),末次随访时第二跖骨相对长度增加(P=0.01)。
结论:p-MICA和d-MICA手术证明了严重外翻畸形的有效矫正潜力;然而,与p-MICA相比,d-MICA手术在最终随访中表现出明显更高的矫正不满意发生率.因此,与p-MICA相比,d-MICA在治疗严重的外翻畸形方面可能难以预测。
OBJECTIVE: To date, the surgical treatment of
severe hallux valgus deformity remains challenging despite the various methods presented. This
study aimed to compare the effectiveness of minimally invasive distal chevron Akin osteotomies (d-MICA) and minimally invasive proximal chevron Akin osteotomies (p-MICA) in correcting
severe hallux valgus deformities.
METHODS: This prospective follow-up
study included patients randomly assigned to undergo p-MICA or d-MICA for hallux valgus deformities with a preoperative hallux valgus angle (HVA) ≥ 40° and/or a first to second intermetatarsal angle (IMA) ≥ 16°. After a minimum follow-up period of two years, we compared various clinico-radiographic parameters of patients whose HVA exceeded 15° at the final follow-up.
RESULTS: In the p-MICA and d-MICA groups, seven of 40 cases (17.5%) and 16 of 41 cases (39.0%), respectively, exhibited HVA > 15° at the final follow-up (P = 0.048). The preoperative parameters showed no significant differences. However, at the first weight-bearing assessment, the HVA, IMA, and relative second metatarsal length were significantly smaller, and the distal metatarsal articular angle (DMAA) was greater in the p-MICA group (all P < 0.05) compared with the d-MICA group. Postoperatively, both groups exhibited significant decreases in HVA and IMA at the final follow-up (P < 0.001 for all parameters). The p-MICA group showed no significant changes in DMAA and the relative length of the second metatarsal (P = 0.253 and 0.185, respectively). However, the d-MICA group showed a significant decrease in DMAA (P < 0.001) and an increase in the relative length of the second metatarsal at the final follow-up (P = 0.01).
CONCLUSIONS: p-MICA and d-MICA procedures demonstrated effective correction potential for severe hallux valgus deformities; however, the d-MICA procedure exhibited a notably higher incidence of unsatisfactory correction at the final follow-up than p-MICA. Therefore, d-MICA may be less predictable in achieving successful outcomes than p-MICA in treating
severe hallux valgus deformities.