Orta derecedeki halluks valgus hastalarında distal chevron osteotomisi ve modifiye mcbride bunyonektomi yöntemlerinin karşılaştırılması
Comparison of chevron osteotomy and modified mcbride bunionectomy for moderate hallux valgus deformity
- Tez No: 680876
- Danışmanlar: PROF. DR. CEMİL KAYALI
- Tez Türü: Tıpta Uzmanlık
- Konular: Ortopedi ve Travmatoloji, Orthopedics and Traumatology
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2021
- Dil: Türkçe
- Üniversite: Sağlık Bilimleri Üniversitesi
- Enstitü: İzmir Bozyaka Eğt. ve Arş. Hast.
- Ana Bilim Dalı: Ortopedi ve Travmatoloji Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 71
Özet
Amaç: Bu çalışmanın amacı S.B.Ü. İzmir Bozyaka Eğitim ve Araştırma Hastanesi Ortopedi Kliniği'nde 16.07.2012-16.05.2019 tarihleri arasında halluks valgus tanısı ile opere edilen orta derecede deformiteye sahip hastalardaki distal Chevron osteotomisi ve McBride bunyonektomi yöntemlerinin sonuçlarının karşılaştırılmasıdır. Gereç ve yöntemler: Çalışmaya S.B.Ü Bozyaka Eğitim ve Araştırma Hastanesi Tıpta Uzmanlık ve Eğitim Kurulu'ndan (30.09.2019/İzmir Karar No:2019/01) onay alındıktan sonra başlanmıştır. 2 gruptaki hastalar VAS, AOFAS skorları, radyolojik açı değişimleri ile komplikasyonlar açısından karşılaştırıldı. Veriler, SPSS-24 (SPSS INC., Chicago, IL, USA) programına kaydedildi. İstatistiksel analizde bağımlı gruplarda t-testi, Wilcoxon işaretli sıralar testi, bağımsız gruplarda t-testi, ki-kare ve Mann Whitney-u yöntemleri kullanıldı. p
Özet (Çeviri)
The aim of this study was to compare the results of distal Chevron osteotomy and McBride bunionectomy techniques in hallux valgus patients with moderate deformity who were operated on between June 2012 and May 2019 in the Orthopedic Clinic of Health Sciences University Izmir Bozyaka Training and Research Hospital. METHOD This study was approved by the University of Health Sciences, İzmir Bozyaka Education and Research Hospital local research ethics committe (2019/01). Results were compared in terms of visual analog scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scores, radiological angle changes and complications. The data was recorded to SPSS-24 (SPSS INC., Chicago, IL, USA) program and independent, dependent t-test, Wilcoxon signed-rank test, chi-square test, and Mann Whitney-U test were used for statistical analysis. RESULTS Twenty-five patients and twenty-seven patients were included in this study who were operated on with distal Chevron osteotomy and Mcbride bunionectomy techniques respectively. Of the 52 patients, 40 patients were female. The mean follow-up period was 3.5±1.8 years. The mean age was 43.20±14.02 years and 46.89±14.77 years in the Chevron and Mcbride group respectively. There were no significant difference in terms of age between two group. The mean hallux valgus angle and the mean preoperative intermetatarsal angle (IMA) were measured preoperatively in Chevron group as 35.9°±3.2° and 13.3°±1.5° and the same parameters in Mcbride group were 33.8°±3.8° and 12.7°±2.8°respectively. There was no statistcal difference between Chevron and Mcbride groups in terms of preoperative HVA and IMA. While HVA was 11.72°±6.03° and IMA was 9.06°±1.59° during the early postoperative period, HVA was 20.44°±10.35° and IMA 9.34°±1.80° during the late postoperative period in the Chevron group. In the Mcbride group, HVA and IMA were measured as 16.40°±7.55° and 9.38°±1.96° respectively during the early postoperative period while 20.03°±7.22° and 10.31°±2.12° during the late postoperative period respectively. There was no significant difference in terms of preoperative and late postoperative HVA and IMA values between Chevron and Mcbride group. However, a significant difference was found in HVA values during early postoperative period. While AOFAS score increased significantly, VAS decreased significantly in the Chevron and Mcbride groups. The change in VAS was significantly higher in the Mcbride group compared to Chevron group. In addition, no significant difference was found in terms of results that were ingrown toenails, pes planus, reoperation, and conservative treatment. The mean mobilization with full weignt-bearing time was 3.8±1.11 week and 1.74±0.81 in the Chevron and Mcbride group respectively. No significant difference was deterrmined between the two groups in terms of mobilization time. CONCLUSION The patient's main complaint and expectations are important during the hallux valgus surgery planning. Before surgery imaging findings should be carefully examined and HVA, IMA, DMAA measurements should be made. In addition, the condition of the sesamoid bones and the length of the metatarsals should be examined. Altough HVA and IMA corrected more in Chevron group, this study showed that there was no significant difference in Mcbride group's result in terms of funtional outcome, pain and patient satisfaction. There was some improvement in the results during the folow-up period. However, the VAS and AOFAS score of the patient was still acceptable. In conclusion, we think that distal Chevron osteotomy and McBride procedure can be applied safely in patients with mild to moderate hallux valgus deformity.
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