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무지 외반증의 근위 갈매기형 절골술 후 고정 방법에 따른 결과 차이

The Differences between Fixation Devices for Proximal Chevron Osteotomy in Hallux Valgus Surgery

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Purpose: The authors evaluated the differences between K-wires and Bold screw for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. Materials and Methods: There were 59 patients (81 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. All patients were followed up at least 6 months. We divided the patients into 2 groups, K-wires fixed group as A, Bold screw fixed group as B. Group A were 42 patients (63 feet) and Group B were 18 patients (19 feet). Among the Group B, 2 feet who were failed to fix the oetotomy site with Bold screw, were fixed with K-wires during operation. We measured the AOFAS score preoperatively, postoperatively and at final follow-up, VAS score at 2 weeks after the operation. Also preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patients. Results: Mean follow up period was 1.34 year (range: 6 months-6.16 years). Mean VAS score of group A was 3.21±1.7 and group B 1.76±1.0. Preoperative mean AOFAS score of group A was 45.61±8.3, group B 44.41±8.9, the final mean score of group A was 88.87±8.3 and group B 92.47±4.4. Preoperative mean HVA was 30.82±6.6 degrees in group A and 32.88±14.5 degrees in group B, the final mean angle of group A was 14.89±8.3 degrees and group B 17±4.4 degrees. The preoperative mean IMA of group A was 13.69±3.6 degrees and group B 12.35±5.2, the final mean angle of group A was 9.26±3.6 degrees and group B 12.35±5.8 degrees. Conclusion: There were no statistical differences in radiologic and clinical results (p>0.05) but, group B exceeded group A in VAS score (p=0.0007) and had no statistical significance in terms of reduction angle loss (p=0.06). Early returning to normal life activity may be possible for patients using Bold screws.

Abstract

Purpose: The authors evaluated the differences between K-wires and Bold screw for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. Materials and Methods: There were 59 patients (81 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. All patients were followed up at least 6 months. We divided the patients into 2 groups, K-wires fixed group as A, Bold screw fixed group as B. Group A were 42 patients (63 feet) and Group B were 18 patients (19 feet). Among the Group B, 2 feet who were failed to fix the oetotomy site with Bold screw, were fixed with K-wires during operation. We measured the AOFAS score preoperatively, postoperatively and at final follow-up, VAS score at 2 weeks after the operation. Also preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patients. Results: Mean follow up period was 1.34 year (range: 6 months-6.16 years). Mean VAS score of group A was 3.21±1.7 and group B 1.76±1.0. Preoperative mean AOFAS score of group A was 45.61±8.3, group B 44.41±8.9, the final mean score of group A was 88.87±8.3 and group B 92.47±4.4. Preoperative mean HVA was 30.82±6.6 degrees in group A and 32.88±14.5 degrees in group B, the final mean angle of group A was 14.89±8.3 degrees and group B 17±4.4 degrees. The preoperative mean IMA of group A was 13.69±3.6 degrees and group B 12.35±5.2, the final mean angle of group A was 9.26±3.6 degrees and group B 12.35±5.8 degrees. Conclusion: There were no statistical differences in radiologic and clinical results (p>0.05) but, group B exceeded group A in VAS score (p=0.0007) and had no statistical significance in terms of reduction angle loss (p=0.06). Early returning to normal life activity may be possible for patients using Bold screws.

참고문헌 (13)

  1. Anderson RB., "Internal fixation of the proximal chevron osteotomy", Foot Ankle Int, 18, pp.371~372 (1997)
  2. Bargman J., "A review of surgical procedures for hallux valgus", Foot Ankle, 1, pp.39~43 (1980)
  3. Bozkurt M., "Stability of a cannulated screw versus a Kirschner wire for the proximal crescentic osteotomy of the first metatarsal: a biomechanical study", J Foot Ankle Surg, 43, pp.138~143 (2004)
  4. Coughlin MJ., "Surgery of the foot and ankle", pp.183~610 (2008), Mosby Inc.
  5. Crosby LA., "Fixation comparison for chevron osteotomies", Foot Ankle Int, 19, pp.41~43 (1998)
  6. Easley ME., "Prospective, randomized comparison of proximal crescentic and proximal chevron osteotomies for correction of hallux valgus deformity", Foot Ankle Int, 17, pp.307~316 (1996)
  7. Lee KT., "Proximal metatarsal chevron osteotomy combined with modified McBride procedures for hallux valgus patients", J Korean Orthop Assoc, 33, pp.1795~1802 (1998)
  8. Lee WC., "Correction of hallux valgus using lateral soft-tissue release and proximal Chevron osteotomy through a medial incision", J Bone Joint Surg, 89(A), pp.82~89 (2007)
  9. Mann RA., "The chevron osteotomy: a clinical and radiographic analysis", Foot Ankle Int, 18, pp.255~261 (1997)
  10. Park HS., "Operative treatment for hallux valgus with proximal metatarsal osteotomy in patients over 55 years old", J Korean Foot Ankle Soc, 9, pp.69~73 (2005)
  11. Petroutsas J., "The Ludloff osteotomy for correction of hallux valgus", Oper Orthop Traumatol, 17, pp.102~117 (2005)
  12. Robinson AH., "Modern concepts in the treatment of hallux valgus", J Bone Joint Surg, 87(B), pp.1038~1045 (2005)
  13. Sammarco GJ., "Bunion correction using proximal chevron osteotomy: a single-incision technique", Foot Ankle Int, 19, pp.430~437 (1998)

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