| Background:Hallux valgus deformity is a disease of the former foot deformity and pain as the main symptoms,often accompanied by the occurrence of the thumb cyst and corpus callosum.With the continuous improvement of the economic level and the continuous development of the foot and ankle surgery in our country,the hallux valgus deformity has received more and more attention,and more and more patients have become involved.The treatment of hallux valgus deformity is currently divided into conservative treatment and surgical treatment.In the industry,surgical treatment is often used for severe deformity of hallux valgus.There are more than 200 surgical methods for correcting hallux valgus deformity.The first metatarsal osteotomy is the main method of surgical treatment.It is divided into the first metatarsal neck osteotomy,the first metatarsal osteotomy and the first Tibial base osteotomy.In such a vast expanse of surgical procedures,how can patients choose the best treatment for this disease,reduce pain and treatment cycle in the treatment process,improve the quality of life of patients,there is no relevant report in this regard.This study mainly focuses on the evidence-based medical research on the efficacy and safety of different parts of hallux valgus osteotomy.Objectives:From the various types of hallux valgus correction orthopedic surgery to screen out the most widely used surgical methods.Scientifically assess the efficacy and safety of the most widely used surgical procedures through systematic reviews and meta-analyses.Provide meaningful reference evidence for the clinical choice of hallux valgus deformity orthopedic surgery,and further improve the surgical treatment of hallux valgus deformity.Method:Firstly,all domestic and foreign literature reports on the different types of osteotomy of hallux valgus have been searched since 2008,and the number of cases,the number of feet and the number of articles have been statistically counted and statistically ranked.It was concluded that the distal Chevron osteotomy accounted for 29.86%and 32.23%respectively in the literature reports and treatment cases at home and abroad.The Scarf osteotomy group accounted for 20.88%and 19.77%,respectively.Both were ranked first and second respectively,and exceeded half of the total sum of all patients with hallux valgus.The distal Chevron osteotomy and Scarf osteotomy were considered to be the two most widely used surgical methods for hallux valgus orthoses in the past ten years.Due to time and energy,this study only addressed the most widely used two parts of the hallux valgus orthopedic surgery,namely the first metatarsal proximal osteotomy-Chevron osteotomy and the first humerus osteotomy-Scarf Osteotomy was evaluated.Retrieve Medline,Embase,and Cochrane Library databases.Main search terms:Hallux valgus,Bunion,Chevron osteotomy,Scarf osteotomy.Strictly follow the established inclusion and exclusion criteria to eliminate documents and systematically evaluate the included studies.Read the full text and extract relevant data on basic demographic data,indicators of efficacy(HVA,IMA,sesamoid location,etc.)and safety indicators(complications such as metastatic bone pain,recurrence,etc.).Baseline comparisons were performed first,and then the same indicator data was used for a meta-analysis using Revman 5.3.To evaluate the efficacy and safety of distal Chevron osteotomy and Scarf osteotomy for correction of hallux valgus deformity.Results:In this study,a total of 1368 articles were retrieved and 24 articles were included.A total of 1,005 subjects,1,294 feet,71 men,and 934 women were included.The first metatarsal distal osteotomy-Chevron osteotomy group had a total of 608 people,799 feet,42 males and 566 females,mean age 49.7 years,mean follow-up time was 38.2 months,preoperative hallux valgus angle(HVA)29.7°.The preoperative first and second metatarsal angle(IMA)was 13.7°.The first metatarsal cadaver osteotomy-Scarf osteotomy group consisted of 397 people,495 feet,29 men and 368 women,with an average age of 51.8 years.The follow-up time was 37.1 months.The preoperative hallux valgus angle(HVA)was 32.7°,and the preoperative first and second metatarsal angle(IMA)was 15°.Meta-analysis showed that the combined effect of corrected HVA was 12.25(14.14,20.36)in the Chevron osteotomy group at 12 months postoperatively,5.74(4.68,6.81)in the corrected IMA,and the combined effect of the correction of sesamoid location was obtained.The amount was 1.55(1.16,1.95),the combined effect of improving AOFAS score was-36.96(-41.95?-31.96),the combined effect of satisfaction was 0.88(0.77,0.98),hallux valgus deformity and hallux varus The combined effect was 0.12(0.04,0.41).The combined effect of humeral head elevation,humeral head collapse,and humeral head necrosis was 0.10(0.01,0.74).Metastatic iliac pain,fractures and dislocations of the lateral iliac crest appeared.The combined effect was 0.09(0.02,0.38);the combined HVA corrected at 12 months after surgery in the Scarf osteotomy group was 16.68(12.75,20.62),and the combined IMA correction was 6.97(5.16,8.78).The combined amount of corrected sesamoids was 1.84(0.93,2.75),the combined improvement in AOFAS score was-39.91(-43.90,-35.92),and the combined amount of satisfaction was 0.96(0.90,1.02),with hallux valgus The combined amount of deformity and hallux varus is 0.11(0.020.51).There were no significant differences in efficacy and comorbidities between the two groups in improving HVA,IMA,sesamoid location,satisfaction,AOFAS score,metastatic patella pain,humeral head necrosis,malformation recurrence,hallux varus,infection,and fracture dislocation..Conclusion:In different parts of the hallux valgus osteotomy surgery,the most widely used clinical practice is the first metatarsal osteotomy on behalf of surgery-Chevron surgery,and the first metatarsal osteotomy on behalf of surgery-Scarf osteotomy.The distal Chevron Osteotomy and Scarf Osteotomy have the same effect on the health status of patients with hallux valgus deformity.They all have significant effects,and the types of complications are different.However,the incidence of complications is also the same.The distal Chevron osteotomy and Scarf osteotomy are the same in terms of correcting the strength of the intertarsal horn(IMA),and academic disputes are related to the measurement method of the postoperative IMA angle.This study recommends the first tibial proximal osteotomy-distal Chevron osteotomy based on the analysis results,because this surgical technique is simpler in technical operation than Scarf osteotomy,and has a short operative time and good healing.However,a number of higher quality randomized controlled trials are still needed to verify support. |
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