Author/Editor     Prlja, Andrej; AvberšekLužnik, Ivica
Title     Operativno zdravljenje haluksa valgusa - vpliv vrst osteotomij na intermetatarzalni, haluks valgus in distalni metatarzalni kot
Translated title     Operative treatment of hallux valgus - the effect of three osteotomy types on the first metatarsal, hallux valgus and metatarsal distal articulation angles
Type     članek
Source     Zdrav Vestn
Vol. and No.     Letnik 76, št. 11
Publication year     2007
Volume     str. 733-7
Language     slo
Abstract     Background Modern approach to hallux valgus deformations enables not only the stage treatment considering the magnitude of the deformity but also the objective evaluation of the results. We investigated the influence of the three most commonly used osteotomies on three most common demonstrative factors, especially proximal osteotomy on the distal metatasal articulation angle. Methods Three groups were created regarding the magnitude of the deformation. X rays of 15 corrections in each group were reviewed (45 cases, 34 women, 2 men). Each group was treated with only one of the three osteotomies: distal chevron osteotomy (Ch), distal chevron osteotomy with medial edge (ChM) and proximal osteotomy (POT). The effect on the three most comonly used demonstrative factors were noted: first intermetatarsal angle (IM), hallux valgus angle (HV), distal metatarsal articulation angle (DMAA). The age and the demonstrative factors were compared pre- and postoperative, in and between the groups. Results The correct, graded selection of the patients for the treatment was confirmed and false negative results excluded. Preoperative values of HV and DMAA are significantely different between three groups (p < 0.001) while IM are not (p = 0.118). Postoperative values of the HV and IM are significantely lower in all three groups (p < 0.001). DMAA is statisticaly different (positive) postoperatively in the ChM group (p < 0.001) but not in the Ch and POT groups (P = 0.398; p = 0.456). Conclusions Modern approach on hallux valgus deformations enables stage treatment and objective evaluation of the results what is demonstrated by the effect of the osteotomies on the demonstrative factors. Further investigations of the factors not yet considered or even unknown are also possible as shown on the example of the difference between the expected and measured effect of POT on DMAA.
Summary     Izhodišča Moderno zdravljenje valgusnih deformacij palca omogoča učinkovito stopenjsko obravnavo glede na velikost deformacije in objektivno ocenjevanje rezultatov kljub še vedno prisotnemu preživetemu očitku naključnosti in neuspešnosti. Zanimal nas je vpliv treh najpogostejših osteotomij na tri najpogostejše kazalce, še posebej vpliv proksimalne osteotomije na naklonski kot glavice prve metatarzalne kosti. Bolniki in metode Oblikovali smo tri skupine bolnikov glede na velikost deformacije nožnega palca. V vsaki skupini smo pregledali rentgenske slike 15 primerov (skupno 45 korekcij stopal pri 34 ženskah in 2 moških). Vsaka skupina je bila zdravljena le z eno od treh najpogostejših vrst osteotomij: distalno osteotomijo (Ch), distalno osteotomijo chevron z medialnim klinom (ChM) in proksimalno osteotomijo (POT). Opazovali smo učinke osteotomij na tri najpogosteje uporabljane kazalce: prvi intermetatarzalni kot (IM), kot haluksa valgusa (HV) in kot naklona sklepne ploskve glavice prve metatarzalne kosti (DMAA). Primerjali smo skupine po starosti in spremembe vrednosti kazalcev pred in po zdravljenju v skupini in zunaj skupin. Rezultati Potrdili smo korekten izbor bolnikov po stopnjah in izvedbo zdravljenja in s tem izključili lažno negativne rezultate. Izhodiščne vrednosti kotov HV in DMAA se med skupinami značilno razlikujejo (p = 0,001), izhodiščne vrednosti kotov IM pa ne (p = 0,118). Pooperativne meritve kotov HV in IM so značilno nižje (p < 0,001) v primerjavi s tistimi pred operacijo pri vseh treh tipih osteotomij. Pri skupini ChM se koti DMAA pred in po operaciji značilno razlikujejo (p < 0,001), pri skupinah Ch in POT pa ne (p = 0,398; p = 0,456). Korekcije pozitivno vplivajo na DMAA pri osteotomijah ChM (p < 0,001). Zaključki Sodobno zdravljenje deformacij haluksa valgusa omogoča učinkovito stopenjsko obravnavo in objektivno vrednotenje uspešnosti, kar prikazujemo z učinki osteotomij na standardne kazalce. (Izvleček prekinjen pri 2000 znakih)
Descriptors     HALLUX VALGUS
OSTEOTOMY
TREATMENT OUTCOME