ABSTRACT
Resumen: Introducción: Hallux valgus (HV) es una patología compleja del antepié, recientemente se ha mostrado interés en el componente rotacional (CR) distal del primer metatarsiano por su relación con recidivas postquirúrgicas de la deformidad. La selección de la técnica quirúrgica es controversial con escasa literatura acerca de la corrección de rotación con osteotomías comunes. Nuestro objetivo es evaluar características radiológicas prequirúrgicas y postquirúrgicas respecto a CR del primer metatarsiano en la cirugía de corrección de HV moderado a severo usando osteotomía de Chevron largo. Material y métodos: Estudio observacional, prospectivo y comparativo en el que se evaluó el CR del primer metatarsiano en nueve pies pertenecientes a seis pacientes con una edad media de 45 años. El CR fue evaluado con base en la metáfisis proximal del primer metatarsiano en fluoroscopías axiales sin carga y AP de pie. Las mediciones se realizaron por un residente de ortopedia y traumatología y un subespecialista en cirugía de pie y Tobillo. Resultados: Se documentaron diferencias significativas (p = 0.05) en el ángulo de pronación prequirúrgico y postquirúrgico al utilizar osteotomía de Chevron largo. El resultado funcional de los pacientes evaluados fue excelente a 11 meses de seguimiento. Conclusiones: Radiológicamente, la corrección rotacional es variable y previamente no se ha reportado en la literatura con esta osteotomía. Se establecen bases morfológicas para la realización de estudios posteriores en la evaluación de rotación de cabeza del primer metatarsiano con diferentes osteotomías.
Abstract: Introduction. Hallux valgus (HV) is a complex forefoot pathology, in which interest has recently been shown in the distal rotational component (CR) of the first metatarsal due to its relationship with postsurgical relapses of the deformity. The selection of surgical technique is controversial with little current literature on the correction of rotation with common osteotomies. The aim of this study is to evaluate preoperative and postoperative radiological characteristics regarding CR of the first metatarsal using long Chevron osteotomy for moderate to severe HV. Material and methods: An observational, prospective and comparative study was carried out in which the CR of the first metatarsal was evaluated in nine feet belonging to six patients with a mean age of 45 years. The RC was evaluated based on the proximal metaphysis of the first metatarsal in axial fluoroscopies of unloaded metatarsals and standing AP. Measurements were performed by an Orthopedic and Traumatology resident and a Foot and Ankle Surgery subspecialist. Results: Significant differences (p = 0.05) were documented in the preoperative and postoperative pronation angle when using long Chevron osteotomy. The functional result of the evaluated patients was excellent at 11 months of follow-up. Conclusions: Radiologically, the rotational correction is variable and has not previously been reported in the literature with this osteotomy. We establishes the morphological bases for the performance of subsequent studies in the evaluation of head rotation of the 1st metatarsal with different osteotomies.
Subject(s)
Humans , Middle Aged , Metatarsal Bones , Hallux Valgus , Osteotomy , Metatarsal Bones/surgery , Metatarsal Bones/diagnostic imaging , Hallux Valgus/surgery , Hallux Valgus/diagnostic imaging , Prospective Studies , Treatment OutcomeABSTRACT
[Objective]To examine the safety and efficacy of closing-opening wedege osteotomy for angular kyphosis.Seven patients with angular kyphotic deformity of the thoracic or thoracolumbar spine were treated by closing-opening wedge osteotomy using a single posterior approach.[Method]Seven patients with angular kyphosis were treated.The apex level of kyphosiswas T5 in one patient,T11 in one,and T12 in five.There was old fracture in five patients,congenital deformity in one,and neurofibromatosis in one.The first 30?~35? of kyphosis were corrected using the closing wedge technique with the hinge of the anterior longitudinal ligament after veretebrectomy and circumspinal decompression of the spinal cord.Then the hinge was moved posteriorly to the spinal cord and the remainder of the requisit angle of osteotomy was corrected using the opening-wedge technique(closing-opening wedge osteotomy).Spinal curvature was stabilized using posterior instrumentation and graft.[Result]Localized kyphosis was reduced from and average of 67? to 18? at 2.2 to 7.5 years ' follow-up.Sagittal alignment from T1 to the sacrum became more physiologic than before.There were no neurologic complications.Bony fusion was achieved in all patients,and there was no correction loss.[Conclusion]Satisfactory correction is safely performed by closing-opening wedged osteotomy with a direct visuzlization of the circumferentiall decompressed spinal cord.Although the performance is technically laborious,it offers good correction without jeopardizing the integrity of the spinal cord.
ABSTRACT
STUDY DESIGN: Retrospective study of 34 ankylosing spondylitis patients with kyphotic deformity who performed correction osteotomy. OBJECTIVES: To assess significance of chin-brow vertical angle for planning and evaluating correction of kyphotic deformity with ankylosis of cervical spine in ankylosing spondylitis patients. SUMMARY OF LITERATURE REVIEW: Accurate assessment and measurement of spinal kyphotic deformity is required when planning treatment and assessing its results. The most reliable measure of trunk deformity is the chin-brow vertical angle. MATERIALS AND METHODS: Thirty-four ankylosing spondylitis patients with cervical ankylosis who had underwent pedicle subtraction extension osteotomy for correction of kyphotic deformity were studied. The patients consisted of 32 male and 2 female patients. Mean age was 35.7 years. Most common apex of kyphosis was T12 in 11 cases. The levels of osteotomy were L1 in 3 case, L2 in 4 cases, L3 in 17 cases, and L4 in 10 cases. Radiographic assessment for sagittal balance was performed by measuring thoracic kyphosis, lumbar lordosis, and distance between the vertical line on anterosuperior point of T1 and that of S1. Chin brow-vertical angle was measured on the preoperative and postoperative clinical photo of the patients. Clinical outcomes were assessed by questionnaire measuring changes in physical function, indoor activity, outdoor activity, psychosocial activity, pain, and patient 's satisfaction with the surgery. RESULTS: Chin brow-vertical angle was 35.5 degrees preoperatively and 1.8 degrees postoperatively. Final follow-up radiograph showed an increase in lumbar lordosis from 5.5 to 43.2 degrees(an increase of 37.7 degrees) while thoracic kyphosis remain stable from 50.4 to 50.2 degrees. Sagittal imbalance significantly improved from 101.5 to12.7 mm. Decreased chin-brow vertical angle correlated negatively with correction angle while chin-brow vertical angle did not correlate with overall clinical outcome. However, the patients with chin brow vertical angle greater than 10 degrees or less than -10 degree had significantly low score concerning the item of horizontal gaze. CONCLUSIONS: The ankylosing spondylitis patient with cervical ankylosis, who had chin-brow vertical angle ranging from -10 to 10 degrees, had better horizontal gaze. Based on the results of this study, measurement of chin-brow vertical angle was recom-mended for planning correction of kyphosis and accurate evaluation of treatment outcome.
Subject(s)
Animals , Female , Humans , Male , Ankylosis , Chin , Congenital Abnormalities , Follow-Up Studies , Kyphosis , Lordosis , Osteotomy , Surveys and Questionnaires , Retrospective Studies , Spine , Spondylitis, Ankylosing , Treatment OutcomeABSTRACT
Kyphotic deformity of thoracic or lumbar spine is generally developed as a consequence of Scheuerman's kyphosis, ankylosing spondylitis, congenital kyphosis, tuberculous kyphosis, spinal tumor, senile kyphosis, trauma and extensive laminectomy etc. The method of treatment is usually conservative. However, in severe kyphosis, gross abnormaility and neurologic complications, and the compression of cardiopulmonary system are resulted and then surgery may be indicated. Since the report of spinal osteotomy by Smith-Peterson, several treatment options have been reported. Despite improved techniques for treating spinal kyphotic deformities, correction of severe and acutely angled deformities are less effective and resulting many complications. We propose the use of a new method of posterior closing spinal osteotomy for the treatment of severe and acutely angled kyphotic deformity to minimize the complications and for effective correction. We report the technique and results of this method in two cases of tuberculous kyphosis and a case of ankylosing spondylitis.