Modified Scarf Osteotomy with Medial Capsular Interposition Combined with Metatarsal Shortening Offset Osteotomy

Y. Etani, M. Hirao, K. Ebina, H. Tsuboi, T. Noguchi, G. Okamura, A. Miyama, K. Takami, A. Nampei, S. Tsuji, H. Owaki, S. Okada, J. Hashimoto
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Abstract

Background: Patients who have noninflammatory arthritis of the feet may develop destructive changes on the first metatarsal head and painful dislocation of the metatarsophalangeal (MTP) joint of 1 or more lesser toes. This aim of this study was to compare feet with noninflammatory arthritis and those with rheumatoid arthritis (RA) with respect to the clinical and radiographic outcomes after treatment of these destructive deformities with a modified Scarf osteotomy with medial capsular interposition into the newly formed first MTP joint, combined with metatarsal shortening offset osteotomy. Methods: A retrospective observational study of 93 feet (31 with noninflammatory arthritis and 62 with RA) was performed. Hallux and lesser-toe scores on the Japanese Society for Surgery of the Foot (JSSF) scoring system, a self-administered foot evaluation questionnaire (SAFE-Q), and preoperative and postoperative radiographic parameters were evaluated. Results: There were significant improvements at the time of the final follow-up in the mean scores on the hallux and lesser-toe scales of the JSSF system and in the SAFE-Q score. The postoperative JSSF lesser-toes function score was better for the feet with noninflammatory arthritis feet than the feet with RA. There was no significant difference in the hallux valgus angle (HVA) between 1 month postoperatively and the final follow-up for both groups. Furthermore, the HVA showed a strong correlation between the 1-month and final follow-up values. Conclusions: The combination of the modified Scarf osteotomy with medial capsular interposition and shortening metatarsal offset osteotomy was useful and safe in feet with noninflammatory arthritis. The HVA at 1 month after surgery is useful to predict the HVA within 5 years after surgery. The postoperative clinical score for the lesser toes was better in the feet with noninflammatory arthritis. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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改良围巾截骨联合内侧囊间置联合跖骨缩短偏移截骨
背景:患有非炎症性足部关节炎的患者可能会在第一跖骨头发生破坏性变化,并在1个或多个小脚趾的跖趾趾关节(MTP)关节脱位疼痛。本研究的目的是比较非炎症性关节炎和类风湿关节炎(RA)患者在使用改良的围巾截骨术(内侧包膜插入新形成的第一MTP关节)结合跖骨缩短偏移截骨术治疗这些破坏性畸形后的临床和影像学结果。方法:对93例脚(31例非炎性关节炎,62例类风湿性关节炎)进行回顾性观察研究。根据日本足部外科学会(JSSF)评分系统、自我管理的足部评估问卷(SAFE-Q)以及术前和术后放射学参数评估拇趾和小脚趾评分。结果:在最后随访时,JSSF系统的拇趾和小脚趾量表的平均得分以及SAFE-Q得分均有显著改善。非炎症性关节炎足部术后JSSF小脚趾功能评分优于类风湿关节炎足部。两组患者术后1个月与最后随访时拇外翻角(HVA)无显著差异。此外,HVA在1个月和最终随访值之间显示出很强的相关性。结论:改良的围巾截骨联合内侧囊间置和缩短跖骨偏移截骨术对非炎性关节炎足部有效且安全。术后1个月的HVA对预测术后5年内的HVA有重要意义。非炎性关节炎足部术后小脚趾的临床评分较好。证据等级:治疗性IV级。完整的证据等级描述见作者指南。
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