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DOI: 10.1055/s-2005-918193
© Georg Thieme Verlag Stuttgart · New York
Die modifizierte Ludloff-Osteotomie zur Korrektur der schweren Spreizfußdeformität mit Hallux valgus-Fehlstellung
The Modified Ludloff Osteotomy for Correction of Severe Metatarsus Primus Varus with Hallux Valgus DeformityPublication History
Publication Date:
19 April 2006 (online)
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Zusammenfassung
Studienziel: Diese prospektive Studie untersucht die mittelfristigen klinischen und radiologischen Ergebnisse der modifizierten Ludloff-Osteotomie zur Korrektur der schweren Spreizfußdeformität mit Hallux valgus-Fehlstellung. Methode: 70 Füße bei 67 Patienten zwischen 25 und 78 Jahren (Durchschnittsalter 56 Jahre) konnten für diese prospektiven Analyse gewonnen werden. Sie wurden sowohl präoperativ als auch beim Follow-up nach 37 ± 6 Monaten nach dem American-Orthopaedic-Foot and Ankle Society (AOFAS) Forefoot-Metatarsophalangeal-Interphalangeal-Score evaluiert. Die Röntgenbilder wurden gemäß den Richtlinien der AOFAS analysiert. Als statistisches Verfahren wurde der Wilcoxon Signed Rank-Test verwendet. Ergebnisse: Der AOFAS-Score zeigte eine signifikante (p < 0,0001) Verbesserung von 55,2 ± 15,2 Punkten präoperativ auf 86,6 ± 15,2 Punkte bei der Nachuntersuchung nach 37 ± 6 Monaten. Die AOFAS-Schmerz-Subskala verbesserte sich von 20,2 ± 9,6 Punkte präoperativ auf 37,3 ± 5,7 Punkte beim Follow-up. Dieser Unterschied ist signifikant (p < 0,0001). Der präoperative Hallux valgus (HV)-Winkel wurde signifikant von 37 ± 8° auf 12 ± 11° (p = 0,0001) und der präoperative Intermetatarsal (IM)-Winkel signifikant von 18 ± 2° auf 8 ± 4° verringert (p = 0,0002). Die Sesamoidposition konnte in Relation zum Mittelfußstrahl signifikant verbessert werden (p = 0,0003). Nach 37 ± 6 Monaten zeigte die radiologische Auswertung bei allen nachuntersuchten Patienten einen soliden knöchernen Durchbau der Osteotomie ohne Fehlheilung. Schlussfolgerung: Die Resultate dieser mittelfristigen prospektiven Studie zeigen, dass die modifizierte Ludloff-Osteotomie eine empfehlenswerte Operation zur Korrektur bei schwerem Spreizfuß (IM-Winkel > 15°) mit Hallux valgus-Deformität ist.
Abstract
Aim: The present study investigates the clinical and radiological mid-term results of the modified Ludloff osteotomy, a proximal metatarsal osteotomy for surgical correction of severe metatarsus primus varus with hallux valgus deformity. Method: 70 feet in 67 patients from 25 to 78 years (average age 56 years) were included in this prospective study. The patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot metatarsophalangeal interphalangeal score, which was used preoperatively and at an average follow-up of 37 ± 6 months. Weight-bearing foot radiographs were analysed according to AOFAS guidelines and statistical evaluation was made with the Wilcoxon signed-rank test. Results: The average AOFAS score improved significantly (p < 0.0001) from 55.2 ± 15.2 points preoperatively to 86.6 ± 15.2 points at follow-up. Preoperatively, all patients complained of pain (20.2 ± 9.6 points) which had improved significantly (p < 0.0001) at the latest follow-up (37.3 ± 5.7 points). The average hallux valgus angle (HVA) was 37 ± 8° preoperatively and improved significantly to 12 ± 11° at follow-up (p = 0.0001). The intermetatarsal angle (IMA) improved significantly from 18 ± 2° preoperatively to 8° ± 4° after 37 ± 6 months (p = 0.0002). The sesamoid position improved significantly from preoperative to follow-up (p = 0.0003). Radiographic evaluation of the patients indicated that all examined osteotomies had healed after 37 ± 6 months. Conclusion: This prospective investigation at intermediate follow-up using currently available outcome measures suggests that the Ludloff osteotomy is a suitable procedure for the surgical correction of severe metatarsus primus varus (IMA > 15°) with hallux valgus deformity.
Schlüsselwörter
Hallux valgus - Ludloff-Osteotomie - metatarsale - Osteotomie
Key words
Hallux valgus - Ludloff osteotomy - metatarsal - osteotomy
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