PREOPERATIVE ANALYSIS OF RADIOGRAPHIC FINDINGS IN 516 PATIENTS WITH HALLUX VALGUS DEFORMITY

ABSTRACT Objective: This is a descriptive study to report our method of operative correction for patients with hallux valgus deformities. Methods: From 2006 to 2012, 516 consecutive patients (601 feet) with hallux valgus deformities were treated surgically in our department after conservative treatments were exhausted. The hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and degree of osteoarthritis in the first metatarsophalangeal joint were measured on preoperative plain radiographs of the weight-bearing forefoot. Results: Young patients with severe intermetatarsal deviation received a combined proximal and distal osteotomy of the first metatarsal (n = 21). Patients with low intermetatarsal deviation received a distal metatarsal chevron osteotomy (n = 196), whereas patients with severe intermetatarsal deviation and less flexible deformities without osteoarthritis received a basal metatarsal osteotomy with a distal soft tissue procedure (n = 173). Elderly active patients with osteoarthritis in the first metatarsophalangeal joint received an arthrodesis (n = 100) or resection arthroplasty (n = 58). Conclusion: Determining a few simple angles on plain radiographs of the weight-bearing forefoot in combination with the age and level of activity of patients can help simplify the operative correction method by using the schema we developed. Level of evidence IV, case series.

摘要
研究目的：本研究为描述性研究，旨在报告拇外翻（hallux valgus）畸形患者的手术矫正方法。
研究方法：2006年至2012年间，我科在保守治疗无效后，对516例连续纳入的拇外翻畸形患者（共计601足）实施手术治疗。术前对负重前足X线平片进行测量，内容包括拇外翻角、跖骨间夹角、跖骨远端关节面夹角以及第一跖趾关节骨关节炎程度。
研究结果：针对重度跖骨间偏移的年轻患者，采用第一跖骨远近端联合截骨术治疗，共21例。跖骨间偏移程度较轻的患者，接受跖骨远端Chevron截骨术（chevron osteotomy）治疗，共计196例；而重度跖骨间偏移、畸形柔韧性较差且无骨关节炎的患者，则行跖骨基底截骨联合远端软组织手术，共173例。合并第一跖趾关节骨关节炎的老年活动能力良好患者，分别接受关节融合术（100例）或切除性关节成形术（58例）治疗。
研究结论：通过对负重前足X线平片测量的几项简单角度指标，结合患者年龄与活动水平，可借助本研究制定的手术方案简化手术矫正流程。
证据等级：IV级，病例系列研究。