HALLUKS VALGUS DEFORMİTESİNİN DÜZELTİLMESİ İÇİN UYGULANAN DİSTAL OBLİK METATARSAL OSTEOTOMİSİNİN KLİNİK SONUÇLARI Clinical Outcome of Distal Oblique Metatarsal Osteotomy for Correction of Hallux Valgus Deformity

Year 2017, Volume: 7 Issue: 4, 54 - 60, 13.12.2017

Murat Calbıyık

Abstract

ÖZET

Amaç: Bu çalışmada halluks valgus deformitesinin düzeltilmesi için uygulanan distal oblik metatarsal osteotomisi

(Wilson osteotomisi) ile elde edilen klinik sonuçların sunulması amaçlanmıştır.

Gereç ve Yöntem: Kliniğimizde 2001-2010 yılları arasında hafif halluks valgus deformitesinin düzeltilmesi

için Wilson osteotomisi uygulanan 48 hastaya (36 kadın, 12 erkek; ortalama yaş, 41±13.6 yıl) ait 48 ayak

retrospektif olarak değerlendirilmiştir. Osteotominin klinik sonucunu değerlendirmek için halluks valgus

açısı (HVA), intermetatarsal açısı (IMA), Amerikan Ortopedik Ayak ve Bilek Derneği (AOFAS) skoru, sesamoid

pozisyonu, ilk metatarsofalanjeal eklem hareket aralığı ve ağrı için görsel analog skor (VAS) kullanıldı.

Bulgular: Hastalar cerrahi sonrası 28.5±10.6 ay izlenmiştir. Preoperatif 26.6°±6.8° olan HVA, cerrahiden

üç hafta sonra 7.3°±0.1°’ye düşmüştür (p<0.001). Benzer olarak IMA osteotomi sonrası anlamlı düşüş

göstermiştir (12.7°±2.2°’den 6.4°±2.4°’e, p<0.001). HVA ve IMA’da kaydedilen düşüş son değerlendirmede

de devam etmiştir. Osteotomi sonrası AOFAS skoru 56±13’den 87±12’ye çıkmıştır (p<0.001). Sesamoid

pozisyonu normal sınırlara gelmiştir (3.0±1.7’den 1.1±0.5’e, p=0.008). İlk metatarsofalanjeal eklem

hareket aralığı dorsifleksiyonda artarken (40°±9.0°’dan 50°±12.0°’ye, p<0.001) plantar fleksiyonda azalmıştır

(35.0°±11.0°’den 45°±9.0°’a, p<0.001). Preoperatif 5.7±3.1 olan VAS ağrı skoru, osteotomi sonrası

1.35±0.8’e düşmüştür.

Sonuç: Wilson osteotomisi hafif halluks valgus deformitesinin düzeltilmesinde radyolojik ve klinik olarak

etkilidir ve cerrahi teknik olarak tercih edilmelidir.

Anahtar Sözcu¨kler: Halluks valgus; Metatarsus; Osteotomi; Wilson’s osteotomisi

ABSTRACT

Objective: The aim of the study was to present the clinical results distal oblique metatarsal osteotomy

(Wilson’s osteotomy) for correction of hallux valgus deformity.

Material and Methods: The clinical data of 48 feet of 48 patients (36 females, 12 males; mean age, 41±13.6

years) who underwent Wilson’s osteotomy for correction of mild hallux valgus deformity between 2001-

2010 in our clinic were retrospectively reviewed. The clinical outcome of the osteotomy was evaluated by

hallux valgus angle (HVA), intermetatarsal angle (IMA), the American Orthopaedic Foot and Ankle Society

(AOFAS) score, sesamoid position, range of first metatarsophalangeal joint motion, and visual analogue

scale (VAS) score.

Results: Patients were followed for 28.5±10.6 months after the surgery. HVA decreased significantly from

preoperative 26.6°±6.8° to 7.3°±0.1° at three weeks after the operation (p<0.001). IMA also showed

significant decrease with osteotomy (from 12.7°±2.2° to 6.4°±2.4°, p<0.001). The decrease in both HVA and

IMA was persistent to the last evaluation. AOFAS score significantly improved from 56±13 to 87±17 with

osteotomy (p<0.001). Sesamoid position become within normal limits after the operation (from 3.0±6.7

to 1.1±0.5, p=0.008). Range of motion of first metatarsophalangeal joint increased at dorsiflexion (from

38.0°±9.0° to 47.0°±12.0°, p<0.001) and decreased at plantar flexion (from 35.0°±11.0° to 29.0°±9.0°,

p<0.001). VAS pain score decreased significantly from preoperative 7.72±3.1 points to 1.35±0.8 points at

the last evaluation.

Conclusion: Wilson’s osteotomy provides effective correction of mild hallux valgus deformity both

radiologically and clinically, thus should be considered as an optimal surgical technique.

Keywords: Hallux valgus; Metatarsus; osteotomy; Wilson’s osteotomy

Keywords

HALLUKS VALGUS DEFORMİTESİNİN DÜZELTİLMESİ İÇİN UYGULANAN DİSTAL OBLİK METATARSAL OSTEOTOMİSİNİN KLİNİK SONUÇLARI Clinical Outcome of Distal Oblique Metatarsal Osteotomy for Correction of Hallux Valgus Deformity

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