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고도의 무지 외반증에서 역갈매기형 중족골 절골술 및 Akin 절골술의 치료

Treatment of Severe Hallux Valgus Deformity with Proximal Reverse Chevron Metatarsal Osteotomy and Akin Osteotomy

박재용|강민석|김태훈|오정환|정홍근
대한족부족관절학회 (korean foot and ankle society)|2010.06|대한족부족관절학회지 (journal of korean foot and ankle society)|제14권 제1호|pp. 16-20

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참고문헌

키워드

Akin osteotomySevere hallux valgusProximal reverse chevron metatarsal osteotomy

초록

Purpose: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. Materials and Methods: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle≥40° or intermetatarsal angle≥18°) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal -interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. Results: AOFAS Hallux Metatarsophalangeal - interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from 43.3°(31-58°) preoperatively to 6.8° (-8-27°) postoperatively. The intermetatarsal angle was decreased from 18.4°(11-24°) preoperatively to 5.3° (1-12°) postoperatively. The sesamoid subluxation was improved from 2.8±0.4 preoperatively to 0.4±0.6 postoperatively. Conclusion: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.

Abstract

Purpose: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. Materials and Methods: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle≥40° or intermetatarsal angle≥18°) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal -interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. Results: AOFAS Hallux Metatarsophalangeal - interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from 43.3°(31-58°) preoperatively to 6.8° (-8-27°) postoperatively. The intermetatarsal angle was decreased from 18.4°(11-24°) preoperatively to 5.3° (1-12°) postoperatively. The sesamoid subluxation was improved from 2.8±0.4 preoperatively to 0.4±0.6 postoperatively. Conclusion: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.

참고문헌 (21)

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  11. Pochatko DJ, "Hamilton JJ. Distal chevron osteotomy with lateral release for treatment of hallux valgus deformity", Foot Ankle Int, 15, pp.457~461 (1994)
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  17. Pinney SJ, "Surgical treatment of severe hallux valgus: the state of practice among academic foot and ankle surgeons", Foot Ankle Int, 27, pp.1024~1029 (2006)
  18. Okuda R, "Proximal metatarsal osteotomy for hallux valgus: comparison of outcome for moderate and severe deformities", Foot Ankle Int, 29, pp.664~670 (2008)
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  20. Swanson AB, "Silicone implant arthroplasty of the great toe. A review of single stem and flexible hinge implants", Clin Orthop Relat Res, 142, pp.30~43 (1979)
  21. Mann RA, "The great toe", Orthop Clin North Am, 20, pp.519~533 (1989)

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