CAN THE PERCUTANEOUS CHEVRON AND AKIN (PECA) TECHNIQUE CORRECT THE PRONATION OF THE FIRST METATARSAL IN HALLUX VALGUS?

ABSTRACT Objective Pronation of the first metatarsal in hallux valgus has recently been discussed among foot and ankle surgeons. This study aimed to evaluate the potential radiographic correction of moderate and severe hallux valgus using the percutaneous Chevron and Akin (PECA) technique. Methods We evaluated 45 feet in 38 patients (mean age 65.3 years old [36 - 83]; 4 men; 34 women; 7 bilateral) who underwent surgical correction using the PECA technique. The radiographic images evaluated were anteroposterior radiographs obtained pre- and postoperatively at least 6 months after surgery, including the metatarsophalangeal angle, the intermetatarsal angle, pronation of the first metatarsal, displacement of the distal fragment, medial sesamoid position and bone union. Results All parameters evaluated showed significant postoperative improvement, including correction of pronation of the first metatarsal (p < .05) and position of the sesamoid (p < .05). There was a union of osteotomies in all feet. No complications were observed, such as screw loosening or necrosis of the first metatarsal head. Conclusion The PECA technique can correct pronation of the first metatarsal in moderate and severe hallux valgus, and other deformity-associated parameters. Level of Evidence IV; Case Series.

【摘要】
目的：拇外翻（hallux valgus）患者的第一跖骨旋前（pronation of the first metatarsal）问题，近期已受到足踝外科领域的广泛讨论。本研究旨在评估经皮Chevron截骨联合Akin截骨（percutaneous Chevron and Akin，PECA）术式对中重度拇外翻患者的影像学矫正效果。
方法：本研究纳入38例接受该PECA术式矫正的患者，共计45足；患者平均年龄65.3岁，年龄范围36~83岁，其中男性4例，女性34例，7例为双侧病变。本研究评估的影像学资料为术前及术后至少6个月的足部正位X线片（anteroposterior radiographs），评估指标包括跖趾关节角（metatarsophalangeal angle）、跖骨间角（intermetatarsal angle）、第一跖骨旋前、远端骨块移位（displacement of the distal fragment）、内侧籽骨位置（medial sesamoid position）及骨愈合（bone union）情况。
结果：所有评估指标术后均呈现显著改善，其中第一跖骨旋前矫正（p<0.05）与内侧籽骨位置恢复（p<0.05）效果尤为突出。所有术侧足均实现截骨部位骨愈合，未观察到螺钉松动（screw loosening）、第一跖骨头（first metatarsal head）坏死等相关并发症。
结论：PECA术式可有效矫正中重度拇外翻患者的第一跖骨旋前及其他与畸形相关的影像学参数。本研究证据等级为IV级，研究类型为病例系列（Case Series）研究。