중등도 이상의 무지 외반증에서 근위 초승달형 절골술의 효과

Results of the Proximal Crescentic Osteotomy for Moderate to Severe Hallux Valgus Deformity

  • 이윤태 (국민건강보험관리공단 일산병원 정형외과) ;
  • 김형복 (국민건강보험관리공단 일산병원 정형외과) ;
  • 윤한국 (국민건강보험관리공단 일산병원 정형외과)
  • Lee, Yoon-Tae (Department of Orthopedic Surgery, National Health Insurance Corporation Ilsan Hospital) ;
  • Kim, Hyoung-Bok (Department of Orthopedic Surgery, National Health Insurance Corporation Ilsan Hospital) ;
  • Yoon, Han-Kook (Department of Orthopedic Surgery, National Health Insurance Corporation Ilsan Hospital)
  • 투고 : 2010.04.17
  • 심사 : 2010.05.13
  • 발행 : 2010.06.15

초록

Purpose: The purpose of this study was to retrospectively analyze the clinical and radiologic results of the proximal crescentic osteotomy for moderate to severe hallux valgus deformity. Materials and Methods: Between March 2001 and March 2008, 55 patients (71 feet) who had undergone crescentic osteotomy and distal soft tissue procedure for hallux valgus were followed up for more than one year. The average follow-up period was 15.8 months (12~28 months) and the average age at the time of surgery was 49.8 years (20~69 years). We analyzed the hallux valgus angle (HVA), the first-second intermetatarsal angle (IMA), the length of 1st metatarsal bone and the position of medial sesamoid in preoperative and the last follow-up radiographs. The American Othopeaedic Foot and Ankle Society (AOFAS) score and patient satisfaction were measured by modifying Johnson's method which were used for clinical outcome assessments. Results: The HVA and the IMA were 36.2 and 15.8 degrees preoperatively, and 10.8 and 3.9 degrees at the last follow-up, respectively. The amount of shortening of 1st metatarsal bone averaged $2.3{\pm}1.1$ rum postoperatively. The medial sesamoid position improved from a preoperative average of grade 6.6 to the last follow-up average of grade 1.9. The AOFAS score improved from a preoperative average of 45.3 points to an average 90.6 points at the last follow-up. The patient's satisfaction was completely satisfied in 61 cases (85.9%), satisfied with minor reservations in 6 cases (8.5%), satisfied with major reservations in 2 cases (2.8%), and dissatisfied in 2 cases (2.8%). Conclusion: Proximal crescentic osteotomy produced satisfactory results for moderate to severe hallux valgus deformity.

키워드

참고문헌

  1. Coughlin MJ. Hallux valgus. Instr Course Lect. 46: 357-91, 1997.
  2. Mann RA, Coughlin MJ. Adult hallux valgus. In: Armen S ed Surgery of the foot and ankle. $6^{th}$ ed. Philadelphia: Mosby Co; 1999.167-96.
  3. Lee WC. Disorders of Hallux. In: Foot and ankle. $2^{nd}$ ed. Seoul: Kyohak Co; 2007.49-146.
  4. Kwon DJ, Song SY, Lee KB, Rhee NK, Choi JH. Results of the Ludloff Osteotomy for Moderate to Severe Halllux valgus Deformity. J Korean Foot Ankle Soc. 2007;11:166-70.
  5. Mann RA. Disorders of the first metatarsophalangeal joint. J Am Acad Orthop Surg. 1995;3:34-43.
  6. Hardy RH, Clapham JCR. Observations on hallux valgus based on a controlled series. J Bone Joint Surg Br. 1951; 33:376-91.
  7. Johnson JE, Johnson KA, Unni KK. Persistent pain after excision of an interdigital neuroma. Results of reoperation. J Bone Joint Surg Am. 1988; 70:651-7.
  8. Kang CS, Choi HW. A clinical study of chevron osteotomy in bunion-hallux valgus. J Korean Orthop Assoc. 1989;24: 619-26.
  9. Lee YG, Do SS, Jung SK. Chevron osteotomy for the treatment of hallux valgus. J Korean Orthop Assoc. 1990;25:1712-17.
  10. Mann RA, Coughlin MJ. Hallux valgus-etiology, anatomy, treatment and surgical consideration. Clin Orthop. 1981;157: 7-13.
  11. Easley ME, Kiebzak GM, Davis WH, Anderson RB. Prospective randomized comparision of proximal crescentric and proximal chevron osteotomies for correction of hallux valgus deformity. Foot Ankle Int. 1996;17:307-16. https://doi.org/10.1177/107110079601700603
  12. Mann RA. Decision-Making in bunion surgery. Instr Course Lect. 1990;39:3-13.
  13. Zettl R, Tmka HJ, Easly M, Salzer M, Ritschl P. Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotmy and distal soft-tissue release. Arch Orthop Trauma Surg. 2000;120:397-402. https://doi.org/10.1007/PL00013769
  14. Jung HJ, Shin HK, Chang IS, Lee JK. Correction of Sesamoid after Proximal Metatarsal Osteotomy and Distal Soft Tissue Procedure in Hallux Valgus. J Korean Foot Ankle Soc. 2005; 9:74-80.
  15. Yoo CI, Lee DH, Kim HT. The Effect of Sesamoid Position on Results of Treatment for Hallux Valgus. J Korean Foot Ankle Soc. 2004;8:131-7.
  16. Ryuzo Okuda, Mitsuo Kinositta, Toshito Yasuda, Tsuyoshi Jotoku, Naoshi Kitano, Hiroaki Shima. Postoperative incomplete reduction of the Sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2009;91: 1637-45. https://doi.org/10.2106/JBJS.H.00796
  17. Mann RA, Rucidel S, Graves SC. Repair of hallux valgus with a distal soft tissue procedure and proximal metatarsal osteotomy. A long term follow-up. J Bone Joint Surg Am. 1992;74:124-9.
  18. Thordarson DB, Leventen EO. Hallux valgus correction with proximal metatarsal osteotomy: two year follow-up. Foot and Ankle. 1992;13:321-6. https://doi.org/10.1177/107110079201300605
  19. Mitchell CL, Flemiug JL, Allen R, Glenney C, Sanfonl GA. Osteotomy-bunionectomy for hallux valgus. J Bone Joint Surg Am. 1958;40:41-60.
  20. Wanivenhaus AH, Feldner-Busztin H. Basal osteotomy of the first metatarsal for the correction of metatarsus primus varus associated with hallux valgus. Foot Ankle. 1988;8:335-43.