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Öz

Amaç: Bu çalışmamızda, erişkinlerde gözlenen orta veya ağır dereceli halluks valgus deformitesi olgularında, birinci metatarsın proksimal, medial tabanlı, açık kama osteotomisinde kullanılan modifiye Simmonds-Menelaus tekniğinin klinik ve radyolojik sonuçları sunulmaktadır.Çalışma planı: Halluks valgus nedeniyle 47 hastanın 51 ayağı opere edilmişti. Ortalama yaşı 41.2±14.0 olan hastaların ortalama takip sürelerinin 99.5±36.0 ay olduğu kaydedildi. Hastaların değerlendirmesi cerrahi öncesi, cerrahiden sonra erken dönem ve son takiplerinde çekilen ayakta anteroposterior (AP) ve lateral grafilerle yapıldı. Halluks valgus açısı (HVA), intermetatarsal açı (İA), metatars distal falanks açısı (MDFA), birinci metatars uzunluğu (MU) parametreleri ölçüldü. Klinik değerlendirmede AOFAS halluks metatarsofalangeal-interfalangeal skaladan yararlanıldı.Bulgular: Ortalama HVA cerrahi öncesi 36.9±7.3 derece olarak ölçülürken, cerrahi sonrası erken dönemde bu değerin 16.6±6.2, son takipte ise 28.9±11.5 derece olduğu görüldü. Ortalama İA cerrahi öncesinde 17.3±4.5, cerrahi sonrası erken dönemde 8.8±3.6 ve son takipte 14.3±4.9 derece olarak ölçüldü. Son takipteki ortalama AOFAS halluks metatarsofalangeal-interfalangeal skala puanı ise 71.9±20.1 idi.Çıkarımlar: Literatürdeki diğer çalışma sonuçlarıyla karşılaştırıldığında, erişkinlerde başarılı sonuç alınamamasının proksimal açık kama osteotomi tekniğinin kendisinden mi yoksa internal tespit yetersizliğinden mi kaynaklandığı net olarak anlaşılamamaktadır. Greftin çökmesini önlemek ve düzeltilmiş radyolojik parametrelerin kalıcılığını sağlamak için uygun tespit materyalinin kullanılması şarttır

Anahtar Kelimeler

• Distal yumuşak doku gevşetmesi; halluks valgus; modifiye Simmonds-Menelaus tekniği; proksimal osteotomi

Modified Simmonds-Menelaus procedure for moderate or severe adult hallux valgus

Abstract

Objective: The purpose of this study was to present the clinical and radiological results of modified Simmonds-Menelaus technique, performed as a proximal, medially-based, open-wedge osteotomy of the first metatarsal, in cases of moderate or severe adult hallux valgus deformity.
Methods: Fifty-one feet of 47 patients underwent surgery due to hallux valgus. Mean age was 41.2±14.0 years, and mean follow-up period was 99.5±36.0 months. Patients were evaluated with standing anteroposterior (AP) and lateral radiographies obtained in the preoperative and early postoperative periods, and during final follow-up. The parameters of hallux valgus angle (HVA), intermetatarsal angle (IA), metatarsal distal phalangeal angle (MDPA), and first metatarsal length (ML) were measured. For clinical evaluation, American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) scale was used.
Results: Mean preoperative HVA was 36.9°±7.3°, mean early postoperative HVA was 16.6°±6.2°, and mean final postoperative HVA was 28.9°±11.5°. Mean preoperative IA was 17.3°±4.5°, mean early postoperative IA was 8.8°±3.6°, and mean final postoperative IA was 14.3°±4.9°. Mean AOFAS hallux MTP-IP score was 71.9±20.1 at final follow-up.
Conclusion: From studies in the available literature, it is not clear whether the proximal open-wedge osteotomy technique itself is unsuccessful in adults or the lack of internal fixation led to failure. Application of an adequate fixation material should be used in order to avoid the collapse of the graft and to maintain the correction of the radiological parameters.

Keywords

• Distal soft tissue release
• hallux valgus
• modified Simmonds-Menelaus procedure
• proximal osteotomy

Kaynakça

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