Osteotomía en tejadillo (Chevron) con técnica mínimamente invasiva en la región distal del primer metatarsiano. Evaluación radiológica. [First metatarsal Chevron osteotomy with minimally invasive surgery. Radiological evaluation].
Barra lateral del artículo
Publicado:
feb 12, 2017
Palabras clave:
Hallux valgus, Cirugía mínimamente invasiva, Osteotomía en “tejadillo”.Hallux valgus, minimally invasive surgery, Chevron osteotomy.
Contenido principal del artículo
Resumen
ObjetivoEl objetivo del presente estudio, fue analizar los resultados radiológicos de una osteotomía en tejadillo (“Chevron”) con técnica MIS (Minimally invasive surgery) del primer metatarsiano en una población uniforme de pacientes (hallux valgus moderado).Material y MétodosEntre octubre del año 2013 y noviembre del año 2014, se realizó el tratamiento quirúrgico del hallux valgus mediante una osteotomía en tejadillo (“Chevron”) con técnica MIS del primer metatarsiano en 24 pies correspondientes a 21 pacientes. Todos los pacientes presentaban diagnóstico de hallux valgus moderado.ResultadosEl ángulo intermetatarsiano entre primero y segundo metatarsiano preoperatorio promedio fue de 12,46° (Rango: 11 a 15°; Desvío estándar o DE 1,03). En el postoperatorio se obtuvo el siguiente valor promedio: 8,13° (Rango: 5 a 10°; DE 1,16). La corrección angular fue de 4,33° promedio. El ángulo de hallux valgus preoperatorio promedio fue de 33,96° (Rango: 20 a 40°; DE 4,93). En el postoperatorio, el ángulo metatarsofalángico fue de 8,16° promedio, con rango entre 3° y 15° y con un DE 2,86. La mejoría promedio del ángulo MTF fue de 25,86°.DiscusiónLa corrección radiológica obtenida mediante la técnica mínimamente invasiva de la osteotomía en “tejadillo” confirma un seguro y efectivo procedimiento para el tratamiento del hallux valgus moderado, con correcciones angulares satisfactorias a mediano plazo. El mencionado procedimiento remeda de manera fidedigna la técnica quirúrgica abierta con todas sus virtudes conocidas y no fue encontrado estudio equivalente en la bibliografía.
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del Vecchio, J. J., Ghioldi, M. E., & Raimondi, N. (2017). Osteotomía en tejadillo (Chevron) con técnica mínimamente invasiva en la región distal del primer metatarsiano. Evaluación radiológica. [First metatarsal Chevron osteotomy with minimally invasive surgery. Radiological evaluation]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 82(1), 19-27. https://doi.org/10.15417/633
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Investigación Clínica
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Citas
1. Kelikian H: Hallux Valgus, allied deformities of the forefoot and metatarsalgia, WB Sanders Co., Philadelphia, pp 27-68, 1965.
2. Coughlin MJ: Juvenile hallux valgus. In Coughlin, MJ; Mann, RA (eds.): Surgery of the foot and ankle, 7th edition, Mosby Yearbook, St. Louis, pp. 270-319, 1999.
3. Du Vries H: Surgery of the Foot. C.V. Mosby Co. St. Louis, pp. 346-442, 1959.
4. Mann RA; Coughlin, MJ: Adult Hallux Valgus. In Mann, RA; Coughlin, MJ (eds.): Surgery of the Foot and Ankle, 7th edition, C.V.
Mosby, St. Louis, pp 159-269, 1999.
5. Myerson M: Foot and Ankle disorders, hallux valgus. WB Sanders Co. Philadelphia, pp. 213-289, 1999.
6. Mitchell LA, Baxter DE. A Chevron-Akin double osteotomy for correction of hallux valgus.Foot Ankle. 1991 Aug;12(1):7-14.
7. Austin DW, Leventen EO. A new osteotomy for hallux valgus: a horizontally directed "V" displacement osteotomy of the metatarsal head for hallux valgus and primus varus. Clin Orthop Relat Res. 1981 Jun;(157):25-30.
8. Coughlin, M. J.: Chevron procedure. Contemp. Orthop. 1991; 23:45-49.9.
9. Donnelly RE, Saltzman CL, Kile TA, Johnson KA. Modified chevron osteotomy for hallux valgus. Foot Ankle Int. 1994 Dec;15(12):642-5.
10. Schneider W, Aigner N, Pinggera O, Knahr K. Chevron osteotomy in hallux valgus. Ten-year results of 112 cases. J Bone Joint Surg Br. 2004 Sep;86(7):1016-20.
11. Bai LB, Lee KB, Seo CY, Song EK, Yoon TR. Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity. Foot Ankle Int. 2010 Aug;31(8):683-8.
12. Potenza V, Caterini R, Farsetti P, Forconi F, Savarese E, Nicoletti S, Ippolito E. Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus. Foot Ankle Int. 2009 Jun;30(6):512-6.
13. Magnan B, Pezzè L, Rossi N, Bartolozzi P. Percutaneous distal metatarsal osteotomy for correction of hallux valgus. J Bone Joint Surg Am. 2005 Jun;87(6):1191-1199.
14. Bauer T, de Lavigne C, Biau D, De Prado M, Isham S, Laffenétre O. Percutaneous hallux valgus surgery: a prospective multicenter study of 189 cases. Orthop Clin North Am. 2009 Oct;40(4):505-14.
15. Radwan YA, Mansour AM. Percutaneous distal metatarsal osteotomy versus distal chevron osteotomy for correction of mild-to-moderate hallux valgus deformity. Arch Orthop Trauma Surg. 2012 Nov;132(11):1539-46.
16. Bösch P, Wanke S, Legenstein R. Hallux valgus correction by the method of Bösch: a new technique with a seven-to-ten-year follow-up. Foot Ankle Clin. 2000 Sep;5(3):485-98, v-vi. Review.
17. Gicquel T, Fraisse B, Marleix S, Chapuis M, Violas P. Percutaneous hallux valgus surgery in children: short-term outcomes of 33 cases. Orthop Traumatol Surg Res. 2013 Jun;99(4):433-9.
18. Vernois J. The treatment of the hallux valgus with a percutaneous chevron osteotomy. J Bone Joint Surg Br 2011;93(Suppl IV):482.
19. Redfern D, Perera AM. Minimally invasive osteotomies. Foot Ankle Clin. 2014 Jun;19(2):181-9.
20. Redfern D, Gill I, Harris M. Early experience with a minimally invasive modified chevron and akin osteotomy for correction of hallux valgus. J Bone Joint Surg Br 2011;93(Suppl IV):482.
21. Brogan K, Voller T, Gee C, Borbely T, Palmer S. Third-generation minimally invasive correction of hallux valgus: technique and early outcomes. Int Orthop. 2014 Oct;38(10):2115-21.
22. Fuhrmann RA, Layher F, Wetzel WD. Radiographic changes in forefoot geometry with weightbearing. Foot Ankle Int. 2003 Apr;24(4):326-31.
23. Coughlin MJ, Saltzman CL, Nunley JA 2nd. Angular measurements in the evaluation of hallux valgus deformities: a report of the ad hoc committee of the American Orthopaedic Foot & Ankle Society on angular measurements. Foot Ankle Int. 2002 Jan;23(1):68-74.
24. Mann, RA; Coughlin, MJ: Adult hallux valgus. In Mann, RA; Coughlin, MJ (eds): Surgery of the foot and ankle, 7 th edition, C.V. Mosby, St. Louis, pp 159 – 269, 1999.
25. Miller JW. Distal first metatarsal displacement osteotomy. Its place in the schema of bunion surgery. J Bone Joint Surg Am. 1974 Jul;56(5):923-31.
26. Schneider W, Csepan R, Knahr K. Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery. J Bone Joint Surg Am. 2003 Mar;85-A(3):494-9.
27. Chi TD, Davitt J, Younger A, Holt S, Sangeorzan BJ. Intra and inter-observer reliability of the distal metatarsal articular angle in adult hallux valgus. Foot Ankle Int. 2002;23:722-726.
28. Piggott, H.: The natural history of hallux valgus in adolescence and early adult life. J. Bone and Joint Surg. 1960; 42-B(4):749-760.
29. Coughlin, M. J., and Thompson, F. M.: The high price of high-fashion footwear. In Instructional Course Lectures, The American Academy of Orthopaedic Surgeons. Vol. 44, pp. 371-377. Rosemont, Illinois, The American Academy of Orthopaedic Surgeons, 1995.
30. Johnson, JE; Clanton, TO; Baxter, DE; Gottlieb, MS: Comparison of chevron osteotomy and modified McBride bunionectomy for correction of mild to moderate hallux valgus deformity. Foot Ankle. 12:61 – 68, 1991.
31. Green, MA; Dorris, MF; Baessler, TP; Mandel, LM; Nachlas,
MJ: Avascular necrosis following distal chevron osteotomy of the first metatarsal. J Foot Ankle Surg. 32:617 – 622, 1993.
32. Peterson, DA; Zilberfarb, JL; Greene, MA; Colgrove, RC: Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release. Foot Ankle Int. 15:59 – 63, 1994.
33. Leventen, EO: The chevron procedure. Orthopedics. 13:973– 976, 1990.
34. Meier, PJ; Kenzora, JE: The risks and benefits of distal first metatarsal osteotomies. Foot Ankle. 6:7 – 17, 1985.
35. Peterson, DA; Zilberfarb, JL; Greene, MA; Colgrove, RC: Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release. Foot Ankle Int. 15:59 – 63, 1994.
36. Resch, S; Stenstr¨om, A; Gustafson, T: Circulatory disturbance of the first metatarsal head after chevron osteotomy as shown by bone scintigraphy. Foot Ankle. 13:137 – 142, 1992.
37. Kadakia AR, Smerek JP, Myerson MS. Radiographic results after percutaneous distal metatarsal osteotomy for correction of hallux valgus deformity. Foot Ankle Int. 2007 Mar;28(3):355-60.
38. Huang PJ, Lin YC, Fu YC, et al. Radiographic evaluation of minimally invasive distal metatarsal osteotomy for hallux valgus. Foot Ankle Int 2011;32(5):S503–7.
39. Pochatko DJ, Schlehr FJ, Murphey MD, Hamilton JJ. Distal chevron osteotomy with lateral release for treatment of hallux valgus deformity. Foot Ankle Int. 1994 Sep;15(9):457-61.
40. Potenza V, Caterini R, Farsetti P, Forconi F, Savarese E, Nicoletti S, Ippolito E. Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus. Foot Ankle Int. 2009 Jun;30(6):512-6.
41. J. Vernois, D. Redfern, Percutaneous Chevron; the union of classic stable fixed approach and percutaneous technique, Fuß & Sprunggelenk (2013), http://dx.doi.org/10.1016/j.fuspru.2013.03.001.
42. Brogan K, Voller T, Gee C, Borbely T, Palmer S. Third-generation minimally invasive correction of hallux valgus: technique and early outcomes. Int Orthop. 2014 Oct;38(10):2115-21.
2. Coughlin MJ: Juvenile hallux valgus. In Coughlin, MJ; Mann, RA (eds.): Surgery of the foot and ankle, 7th edition, Mosby Yearbook, St. Louis, pp. 270-319, 1999.
3. Du Vries H: Surgery of the Foot. C.V. Mosby Co. St. Louis, pp. 346-442, 1959.
4. Mann RA; Coughlin, MJ: Adult Hallux Valgus. In Mann, RA; Coughlin, MJ (eds.): Surgery of the Foot and Ankle, 7th edition, C.V.
Mosby, St. Louis, pp 159-269, 1999.
5. Myerson M: Foot and Ankle disorders, hallux valgus. WB Sanders Co. Philadelphia, pp. 213-289, 1999.
6. Mitchell LA, Baxter DE. A Chevron-Akin double osteotomy for correction of hallux valgus.Foot Ankle. 1991 Aug;12(1):7-14.
7. Austin DW, Leventen EO. A new osteotomy for hallux valgus: a horizontally directed "V" displacement osteotomy of the metatarsal head for hallux valgus and primus varus. Clin Orthop Relat Res. 1981 Jun;(157):25-30.
8. Coughlin, M. J.: Chevron procedure. Contemp. Orthop. 1991; 23:45-49.9.
9. Donnelly RE, Saltzman CL, Kile TA, Johnson KA. Modified chevron osteotomy for hallux valgus. Foot Ankle Int. 1994 Dec;15(12):642-5.
10. Schneider W, Aigner N, Pinggera O, Knahr K. Chevron osteotomy in hallux valgus. Ten-year results of 112 cases. J Bone Joint Surg Br. 2004 Sep;86(7):1016-20.
11. Bai LB, Lee KB, Seo CY, Song EK, Yoon TR. Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity. Foot Ankle Int. 2010 Aug;31(8):683-8.
12. Potenza V, Caterini R, Farsetti P, Forconi F, Savarese E, Nicoletti S, Ippolito E. Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus. Foot Ankle Int. 2009 Jun;30(6):512-6.
13. Magnan B, Pezzè L, Rossi N, Bartolozzi P. Percutaneous distal metatarsal osteotomy for correction of hallux valgus. J Bone Joint Surg Am. 2005 Jun;87(6):1191-1199.
14. Bauer T, de Lavigne C, Biau D, De Prado M, Isham S, Laffenétre O. Percutaneous hallux valgus surgery: a prospective multicenter study of 189 cases. Orthop Clin North Am. 2009 Oct;40(4):505-14.
15. Radwan YA, Mansour AM. Percutaneous distal metatarsal osteotomy versus distal chevron osteotomy for correction of mild-to-moderate hallux valgus deformity. Arch Orthop Trauma Surg. 2012 Nov;132(11):1539-46.
16. Bösch P, Wanke S, Legenstein R. Hallux valgus correction by the method of Bösch: a new technique with a seven-to-ten-year follow-up. Foot Ankle Clin. 2000 Sep;5(3):485-98, v-vi. Review.
17. Gicquel T, Fraisse B, Marleix S, Chapuis M, Violas P. Percutaneous hallux valgus surgery in children: short-term outcomes of 33 cases. Orthop Traumatol Surg Res. 2013 Jun;99(4):433-9.
18. Vernois J. The treatment of the hallux valgus with a percutaneous chevron osteotomy. J Bone Joint Surg Br 2011;93(Suppl IV):482.
19. Redfern D, Perera AM. Minimally invasive osteotomies. Foot Ankle Clin. 2014 Jun;19(2):181-9.
20. Redfern D, Gill I, Harris M. Early experience with a minimally invasive modified chevron and akin osteotomy for correction of hallux valgus. J Bone Joint Surg Br 2011;93(Suppl IV):482.
21. Brogan K, Voller T, Gee C, Borbely T, Palmer S. Third-generation minimally invasive correction of hallux valgus: technique and early outcomes. Int Orthop. 2014 Oct;38(10):2115-21.
22. Fuhrmann RA, Layher F, Wetzel WD. Radiographic changes in forefoot geometry with weightbearing. Foot Ankle Int. 2003 Apr;24(4):326-31.
23. Coughlin MJ, Saltzman CL, Nunley JA 2nd. Angular measurements in the evaluation of hallux valgus deformities: a report of the ad hoc committee of the American Orthopaedic Foot & Ankle Society on angular measurements. Foot Ankle Int. 2002 Jan;23(1):68-74.
24. Mann, RA; Coughlin, MJ: Adult hallux valgus. In Mann, RA; Coughlin, MJ (eds): Surgery of the foot and ankle, 7 th edition, C.V. Mosby, St. Louis, pp 159 – 269, 1999.
25. Miller JW. Distal first metatarsal displacement osteotomy. Its place in the schema of bunion surgery. J Bone Joint Surg Am. 1974 Jul;56(5):923-31.
26. Schneider W, Csepan R, Knahr K. Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery. J Bone Joint Surg Am. 2003 Mar;85-A(3):494-9.
27. Chi TD, Davitt J, Younger A, Holt S, Sangeorzan BJ. Intra and inter-observer reliability of the distal metatarsal articular angle in adult hallux valgus. Foot Ankle Int. 2002;23:722-726.
28. Piggott, H.: The natural history of hallux valgus in adolescence and early adult life. J. Bone and Joint Surg. 1960; 42-B(4):749-760.
29. Coughlin, M. J., and Thompson, F. M.: The high price of high-fashion footwear. In Instructional Course Lectures, The American Academy of Orthopaedic Surgeons. Vol. 44, pp. 371-377. Rosemont, Illinois, The American Academy of Orthopaedic Surgeons, 1995.
30. Johnson, JE; Clanton, TO; Baxter, DE; Gottlieb, MS: Comparison of chevron osteotomy and modified McBride bunionectomy for correction of mild to moderate hallux valgus deformity. Foot Ankle. 12:61 – 68, 1991.
31. Green, MA; Dorris, MF; Baessler, TP; Mandel, LM; Nachlas,
MJ: Avascular necrosis following distal chevron osteotomy of the first metatarsal. J Foot Ankle Surg. 32:617 – 622, 1993.
32. Peterson, DA; Zilberfarb, JL; Greene, MA; Colgrove, RC: Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release. Foot Ankle Int. 15:59 – 63, 1994.
33. Leventen, EO: The chevron procedure. Orthopedics. 13:973– 976, 1990.
34. Meier, PJ; Kenzora, JE: The risks and benefits of distal first metatarsal osteotomies. Foot Ankle. 6:7 – 17, 1985.
35. Peterson, DA; Zilberfarb, JL; Greene, MA; Colgrove, RC: Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release. Foot Ankle Int. 15:59 – 63, 1994.
36. Resch, S; Stenstr¨om, A; Gustafson, T: Circulatory disturbance of the first metatarsal head after chevron osteotomy as shown by bone scintigraphy. Foot Ankle. 13:137 – 142, 1992.
37. Kadakia AR, Smerek JP, Myerson MS. Radiographic results after percutaneous distal metatarsal osteotomy for correction of hallux valgus deformity. Foot Ankle Int. 2007 Mar;28(3):355-60.
38. Huang PJ, Lin YC, Fu YC, et al. Radiographic evaluation of minimally invasive distal metatarsal osteotomy for hallux valgus. Foot Ankle Int 2011;32(5):S503–7.
39. Pochatko DJ, Schlehr FJ, Murphey MD, Hamilton JJ. Distal chevron osteotomy with lateral release for treatment of hallux valgus deformity. Foot Ankle Int. 1994 Sep;15(9):457-61.
40. Potenza V, Caterini R, Farsetti P, Forconi F, Savarese E, Nicoletti S, Ippolito E. Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus. Foot Ankle Int. 2009 Jun;30(6):512-6.
41. J. Vernois, D. Redfern, Percutaneous Chevron; the union of classic stable fixed approach and percutaneous technique, Fuß & Sprunggelenk (2013), http://dx.doi.org/10.1016/j.fuspru.2013.03.001.
42. Brogan K, Voller T, Gee C, Borbely T, Palmer S. Third-generation minimally invasive correction of hallux valgus: technique and early outcomes. Int Orthop. 2014 Oct;38(10):2115-21.