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Title: [Effectiveness of minimally invasive treatment of hallux valgus with small incision external articular osteotomy].
Author: Zhang Y, Yuan Y, Guan G, Liu Y, Sun G.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2024 Jul 15; 38(7):855-861. PubMed ID: 39013824.
Abstract:
OBJECTIVE: To compare the effectiveness of small incision external articular minimally invasive osteotomy and traditional Chevron osteotomy in the treatment of hallux valgus. METHODS: A retrospective analysis was conducted on the clinical data of 58 patients (58 feet) with hallux valgus who were admitted between April 2019 and June 2022 and met the selection criteria. Among them, 28 cases were treated with small incision external articular minimally invasive osteotomy (minimally invasive group), and 30 cases were treated with traditional Chevron osteotomy (traditional group). There was no significant difference in baseline data such as age, gender, disease duration, Mann classification, and preoperative inter metatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), forefoot width, tibial sesamoid position (TSP) score, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) score, psychological score (SF-12 MCS score) and physiological score (SF-12 PCS score) of short-form 12 health survey scale, and range of motion (ROM) of metatarsophalangeal joint between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, weight-bearing walking time, fracture healing time, and incidence of complications were recorded and compared between the two groups; as well as the changes of imaging indexes at last follow-up, and the clinical function score and ROM of metatarsophalangeal joint before operation, at 6 weeks after operation, and at last follow-up. RESULTS: All patients were followed up 11-31 months, with an average of 22 months. The incision length and intraoperative blood loss in the minimally invasive group were significantly less than those in the traditional group ( P<0.05), and the intraoperative fluoroscopy frequency and operation time in the minimally invasive group were significantly more than those in the traditional group ( P<0.05); but no significant difference was found in weight-bearing walking time and fracture healing time between the two groups ( P>0.05). There was 1 case of skin injury in the minimally invasive group and 3 cases of poor incision healing in the traditional group; all patients had good healing at the osteotomy site, and no complication such as infection, nerve injury, or metatarsal head necrosis occurred. At last follow-up, the imaging indexes of the two groups significantly improved when compared with those before operation ( P<0.05). The changes of DMAA and TSP score in the minimally invasive group were significantly better than those in the traditional group ( P<0.05), and there was no significant difference in the changes of IMA, HVA, and forefoot width between the two groups ( P>0.05). The clinical scores and ROM of metatarsophalangeal joint significantly improved in the two groups at 6 weeks after operation and at last follow-up when compared with preoperative ones ( P<0.05), and the indicators in the minimally invasive group were significantly better than those in the traditional group ( P<0.05). CONCLUSION: Compared with traditional Chevron osteotomy, small incision external articular minimally invasive osteotomy can effectively improve HVA, IMA, and forefoot width, correct foot deformities, and has less trauma. It can better correct the first metatarsal pronation deformity and restore the anatomical position of the sesamoid bone, resulting in better effectiveness. 目的: 比较小切口关节外微创截骨与传统Chevron截骨术治疗踇外翻的临床疗效。. 方法: 回顾分析2019年4月—2022年6月收治且符合选择标准的58例（58足）踇外翻患者临床资料，其中28例采用小切口关节外微创截骨（微创组），30例采用传统Chevron截骨术截骨（传统组）。两组患者年龄、性别、病程、Mann分型及术前第1、2跖骨间角（inter metatarsal angle，IMA）、踇外翻角（hallux valgus angle，HVA）、跖骨远端关节面角（distal metatarsal articular angle，DMAA）、前足宽度、胫侧籽骨位置（tibial sesamoid position，TSP）评分、美国矫形足踝协会（AOFAS）前足评分、疼痛视觉模拟评分（VAS）、健康调查 12 项简表的心理评分（SF-12 MCS评分）和生理评分（SF-12PCS评分）及跖趾关节活动度（range of motion，ROM）等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者切口长度、手术时间、术中出血量、术中透视次数、负重行走时间、骨折愈合时间及并发症发生情况，末次随访时各影像学指标与术前比较的变化值，术前、术后6周及末次随访时临床评分以及跖趾关节ROM。. 结果: 所有患者均获随访，随访时间11～31个月，平均22个月。微创组患者切口长度、术中出血量小于传统组，术中透视次数、手术时间大于传统组，差异均有统计学意义（ P<0.05）；两组负重行走时间和骨折愈合时间比较差异无统计学意义（ P>0.05）。微创组出现1例皮肤损伤，传统组出现3例切口愈合不良；所有患者截骨处愈合良好，无感染、神经损伤及跖骨头坏死等并发症发生。末次随访时两组患者各影像学指标均较术前显著改善（ P<0.05）；末次随访时微创组DMAA和TSP评分变化值优于传统组（ P<0.05），两组间IMA、HVA及前足宽度变化值差异均无统计学意义（ P>0.05）。术后6周及末次随访时，两组患者各临床评分及跖趾关节ROM均较术前显著改善（ P<0.05）；微创组各指标均优于传统组，差异有统计学意义（ P<0.05）。. 结论: 与传统Chevron截骨术相比，小切口关节外微创截骨不仅可有效改善HVA、IMA、前足宽度，矫正足部畸形，且创伤小，能更好地纠正第1跖骨旋前畸形及恢复籽骨解剖位置，临床疗效更佳。.

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