The Clinical Effect of the Combination of Adductor Tenotomy from a Single Medial Incision and Chinese Manipulation for Hallux Valgus
|School||China Academy of Traditional Chinese Medicine|
|Course||Traditional Chinese Medicine|
|Keywords||minimally invasive adductor hallucis hallux valgus (HV)|
Adductor tenotomy is a common surgical method for hallux valgus(HV), which is widely combinated with osteotomy. The routine approach of adductor tenotomy is the lateral incision of the first metatarso-phalangeal joint. There is the possibility of vas-cular nerve injury. Cause of the osteotomy needed a medial incision, avascular necro-sis of the first metatarsal head may occur at the situation of vascular transport impact on both sides of the head of the first metatarsal. A modus operandi reducing incision was design against the complications combined with intraoperative and postoperative Chinese manipulation, in order to play a positive role to prevent adhesion after ad-ductor tenotomy. Then the clinical effect of adductor tenotomy from a medial incision in20cases control with a routine lateral incision was observed to evaluate the effica-cy and advantages of the combination of adductor tenotomy from a single medial in-cision and Chinese manipulation for HV.Objective:To compare the clinical effect and safety of the combination of ad-ductor tenotomy from a single medial incision and Chinese manipulation with adduc-tor tenotomy from a routine lateral incision.Methods:40patients in accordance with the inclusion criteria from "foot and an-kle clinic" at the department of orthopedics, Guang’anmen hospital divided into2groups by Block randomization method. Observed group in20cases were underwent adductor tenotomy from a single medial incision and Chinese manipulation:lateral articular capsulotomy was done from medial osteotomy operation incision firstly, then medial articular capsulotomy and adductor tenotomy were done in straight viewing after axial stretching and dislocating the first metatarsophalangeal joint, conventional osteotomy was operated finally. Lateral articular capsule was released by intraopertaive Chinese manipulation, and hallux was fixed postoperatively by a plant-let to hold in alignment. Passive functional exercise toward varus position was started at the second day after surgery.20cases of the control group were applied routine first toeweb approach to amputate adductor hallucis tendon, and then osteotomy through medial incision. The pull numerical values while pulling toe to hallux valgus an-gle(HVA)=0°during and12th week after operation, the HVA value of preoperation,2nd day and12th week after operation, the length of surgical incision, AOFAS score before and12th week after operation were observed. The degree of releasing and postoperative adhesions of adductor hallucis and lateral articular capsule, HVA cor-rection capability, operative trauma, and improvement of function of hallux-metatarsophalangeal joint-interphalangeal joint between two groups were compared.Results:The mean pull pull numerical values during and12-week after operation were (6.04±2.52)N to (10.10±2.02)N at observed group, and (6.25±2.47)N to (12.05±2.08)N at control group. The pull numerical values of both groups12-week after operation were increased comparing with intraoperation (P<0.001), and the range of observed group lower than control group (P<0.05). The HVA of preoperation,2nd day and12th week after operation at observed group were respec-tively (34.25±6.17)°,(11.20±2.97)°and (12.30±2.45)°; while the control groups were respectively (34.40±8.12)°,(11.30±3.71)°and (14.80±2.62)°. HVA of2nd day and12th week after operation were decreased at both groups (P<0.001), while the differentiation between groups hadn’t statistical significance (P>0.05). The total length of surgical incision in observed group were smaller less than that of control group [(3.48±0.36)cm vs (5.06±0.68)cm; P<0.001]. The AOFAS at observed group increased from pre-operatively46.75±9.12to12th week post-operatively86.40±6.35; and the AOFAS at control group increased from pre-operatively47.40±9.26to12th week post-operatively85.85±7.33. AOFAS score of both groups12-week after opera-tion were increased comparing with preoperation (P<0.001), but without differentia-tion between two groups (P>0.05). There were no any adverse events at both groups, such as infection, nonunion or delayed healing of incision, nerve and blood vessel in-jury, and avascular necrosis of the head of the first metatarsal. Conclusion:The clinical effect of the combination of adductor tenotomy from a single medial incision and Chinese manipulation was corresponded to routine ap-proach. Furthermore, it was benefit in preventing postoperation adhesion. It was an effective method for HV with fewer traumas.