Abstract：Objective This study aims to compare the clinical effect of modified-slot single-screw Scarf osteotomy and traditional Scarf osteotomy for treatment of hallux valgus deformity. Methods A retrospective cohort study was conducted. The clinical data of 39 patients (48 feet) with moderate and severe hallux valgus admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from January 2018 to January 2021 were included (37 females and 2 males, aged 28-77 [54.5±12.2] years). According to different surgical methods, 21 patients (30 feet) in the modified single-screw Scarf group were female aged 29-77 (52.6±13.2) years and were treated with the modified osteotomy. The traditional Scarf group consisted of 18 patients (18 feet) including 2 males and 16 females aged 28-74 (57.7±9.9) years who were treated with the traditional osteotomy. The observation items were as follows. (1) The weight-bearing CT radiographic parameters of the two groups were compared before surgery and at the last follow-up. These parameters included hallux valgus angle (HVA), first and second intermetatarsal angle (IMA), distal metatarsal articular surface angle, (DMAA), first metatarsal rotation angle (α angle), and amount of correction, tibial sesamoid coronal grading (TSCG). (2) The operative effect was compared using the American Orthopedic Society for Foot and Ankle (AOFAS) forefoot score. visual analog scale (VAS) score, and postoperative complications. Results Thirty-nine patients (48 feet) were followed up for 6-24 (10.6±3.6) months. All the patients' wounds healed in stage I without infection or recurrence. No significant difference was found in the baseline data of age, body mass index(BMI), follow-up time, side, sex, type, complications, and combined operation between the modified and traditional Scarf groups (all P values > 0.05). Preoperative HVA, IMA, DMAA, TSCG, and α angle were not significantly different between the two groups (all P values > 0.05). At the last follow-up, the difference between postoperative DMAA and preoperative DMAA was not significant in the traditional Scarf group (Z=-0.54, P=0.586). The other indicators in the two groups were improved compared with those before the operation (all P values < 0.05). No significant differences in HVA, HVA correction amount, and IMA were also found between the two groups (all P values > 0.05). However, the IMA correction amount, α angle and their correction amount, DMAA and their correction amount, TSCG in the modified single-screw Scarf group were better than those in the traditional Scarf group, and the differences were statistically significant (all P values<0.05). The comparison of AOFAS and VAS scores between the two groups showed no significant difference before surgery (all P values>0.05) but indicated significant improvement in the last follow-up compared with the preoperative scores (all P values < 0.001). At the last follow-up, no significant difference in the VAS score was found between the two groups (Z=-1.18,P=0.236); however, the AOFAS score of the modified group was better than that of the traditional group, with values of 100.0 (92.3,100) and 90.0 (86.8,100) points, respectively, and the difference was statistically significant (Z=-1.80, P=0.007). The traditional group had one case of metataralgia. No complications occurred in the modified group during follow-up. Conclusion The the two osteotomy methods can effectively correct hallux valgus deformity. Compared with the traditional Scarf osteotomy, the modified-slot single-screw Scarf osteotomy has stronger correction ability, wider application range, and fewer postoperative complications and exhibits outstanding performance in correcting the pronation of the first metatarsal.
王超, 王智, 孙超, 张建中, 王显军, 丁声龙, 张明珠. 改良卡槽单钉Scarf截骨术与传统Scarf截骨术治疗足拇外翻畸形效果的比较[J]. 中华解剖与临床杂志, 2023, 28(7): 423-430.
Wang Chao, Wang Zhi, Sun Chao, Zhang Jianzhong, Wang Xianjun, Ding Shenglong, Zhang Mingzhu. Comparison of modified-slot single-screw Scarf osteotomy and traditional Scarf osteotomy for hallux valgus deformity. Chinese Journal of Anatomy and Clinics, 2023, 28(7): 423-430.
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2023, Vol. 28 
