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Z Orthop Unfall 2012; 150(06): 594-600
DOI: 10.1055/s-0032-1327933
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Georg Thieme Verlag KG Stuttgart · New York

Modifizierte Chevron-Osteotomie mit lateralem Release und Schraubenfixation zur Behandlung der schweren Hallux-valgus-Deformität

Modified Chevron Osteotomy with Lateral Release and Screw Fixation for Treatment of Severe Hallux Deformity
S. G. Hofstaetter
1   Abteilung für Orthopädie, Klinikum Wels-Grieskirchen, Wels, Österreich
,
R. Schuh
2   Abteilung für Orthopädie, Medizinische Universtät Wien, Wien, Österreich
,
K. Trieb
1   Abteilung für Orthopädie, Klinikum Wels-Grieskirchen, Wels, Österreich
,
H. J. Trnka
3   Orthopädie, Fusszentrum Wien, Wien, Österreich
› Author Affiliations
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Publication History

Publication Date:
09 January 2013 (online)

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Zusammenfassung

Hintergrund: Diese prospektive Studie untersucht die klinischen und radiologischen Ergebnisse der Chevron-Osteotomie mit Schraubenfixation und distalem Weichteilrelease bis zu einem Intermetatarsalwinkel von 19°. Weiters sollen die Ergebnisse bei Patienten über dem 70. Lebensjahr präsentiert werden, und ob es in diesen Patientengruppen zu einer erhöhten Komplikationsrate kommt.

Material und Methode: 86 Füße von Patienten zwischen 23 und 81 Jahren konnten in die Studie eingeschlossen werden. Neben der Gesamtgruppe wurden die Gruppe mit einem Intermetatarsalwinkel von 16° bis 19° sowie die Patientengruppe über 70 Jahre evaluiert. Sie wurden sowohl präoperativ als auch beim Follow-up nach durchschnittlich 3,3 Jahren mit dem American Orthopaedic Foot and Ankle Society Score evaluiert.

Ergebnisse: Der AOFAS-Score zeigte eine signifikante Verbesserung von 55 Punkten präoperativ auf 90 Punkte bei der Nachuntersuchung. Der präoperative Hallux-valgus-Winkel wurde signifikant von 32° auf 5° und der präoperative Intermetatarsalwinkel signifikant von 14° auf 6° verringert. Die Patientenzufriedenheit der Gesamtgruppe war in 92 % sehr gut und gut. Auch die Patientengruppe von 16–19° und die Patienten über 70 Jahre zeigten eine signifikante Verbesserung der klinischen und radiologischen Parameter. Die Komplikationsrate war in allen Gruppen sehr gering.

Schlussfolgerung: Die Resultate zeigen, dass die Chevron-Osteotomie eine sehr gute und komplikationsarme Operation zur Korrektur bei Spreizfuß mit Hallux-valgus-Deformität ist. Wir konnten zeigen, dass durch die modifizierte Technik mit einem längeren plantaren Schenkel, einer ausgedehnten Weichteiltechnik und durch die Schraubenfixation die Indikation bis zu einem Intermetatarsalwinkel von 19° ausgedehnt werden kann. Weiters zeigte auch die Patientengruppe über 70 Jahre eine signifikante Verbesserung der klinischen und radiologischen Parameter ohne schwere Komplikationen wie Köpfchenverkippung oder avaskuläre Nekrose.

Abstract

Background: This prospective study examined the clinical and radiological results of the Chevron osteotomy with screw fixation and distal soft tissue release up to an intermetatarsal angle of 19°. Furthermore, the results are presented for patients over the age of 70 years, and whether or not there is a higher complication rate.

Material and Methods: 86 feet of patients between 23 and 81 years were included in the study. Apart from the overall group, a group with an intermetatarsal angle of 16° to 19° and a group of patients over 70 years old were eavaluated. They were evaluated preoperatively and at follow-up after an average of 3.3 years according to the American Orthopaedic Foot and Ankle Society score.

Results: The AOFAS score showed a significant improvement from 55 points preoperatively to 90 points at follow-up. The preoperative hallux valgus angle decreased significantly from 32° to 5° and the preoperative intermetatarsal angle decreased from 14° to 6°. Patient satisfaction in the overall group was rated in 92 % as excellent or good. Also, the patient group with 16° to 19° angles and the patients over 70 years showed a significant improvement of clinical and radiological parameters. The complication rate was very low in all groups.

Conclusion: The results show that the Chevron osteotomy is a very good surgical technique with few complications for the correction of splay foot with hallux valgus deformity. We showed that by using the modified technique with a long plantar arm, an excessive soft tissue release and screw fixation, the indication can be extended up to an intermetatarsal angle of 19° when using screw fixation. Furthermore the patients over 70 years of age showed a significant improvement of clinical and radiological parameters without serious complications such as avascular necrosis or dislocation of the metatarsal head.

Schlüsselwörter

Spreizfuß - Chevron - Metatarsale - Osteotomie

Key words

splay foot - Chevron - metatarsal - osteotomy
 

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