Mičelova i Goldenova metatarzalna osteotomija u lečenju umerenih deformiteta čukljeva: uporedna analiza

  • Nadan Mikić Klinicko odeljenje ortopedije sa traumatogijom, KCB "Zvezdara"
  • Dušanka Grujoska-Veta University Clinic for Orthopaedic Surgery, Skoplje, Republic of North Macedonia
  • Goran Čobeljić University of Belgrade, Faculty of Medicine, Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Ismet Gavankapetanović Clinical Center, Clinic of Orthopaedics and Traumatology, Sarajevo, Bosnia and Hercegovina
  • Zoran Vukašinović University of Belgrade, Faculty of Medicine, Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Ivan Soldatović University of Belgrade, Faculty of Medicine, Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Miroslava Popović Zvezdara University Medical Center, Clinical Department of Orthopaedics and Traumatology, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP161230105M
Ključne reči: halkus valgus;, osteotomija;, hirurgija, operativne procedure;, lečenje, ishod.

Sažetak


Uvod/Cilj. Mada se operativno lečenje čuklja primenjuje duže od 100 godina, još uvek nije ustanovljena tehnika koja bi se mogla smatrati takozvanim zlatnim standardom. Cilj rada bio je poređenje postoperativnih rezultata postupaka po Mitchell-u i Golden-u u lečenju umerenih deformiteta hallux valgus-a. Metode. U opservacionoj studiji kontrole slučajeva (case control) učestvovalo je 49 pacijenata (81 stopalo) operisanih distalnom osteotomijom I metatarzalne kosti po Mitchell-u i 49 pacijenata (77 stopala) operisanih proksimalnom osteotomijom I metatarzalne kosti po Golden-u. Za procenu rezultata lečenja korišćene su: Klasifikacija po Boney i McNab-u modifikovana po Hellal-u i Hallux Metatarsophalangeal Interphalangeal Score (HMIS). Rezultati su statistički obrađeni, a vrednosti p < 0,05 uzete su kao statistički značajne. Rezultati. Oba hirurška postupka su pokazala uspešne statistički visoko značajno bolje postoperativne rezultate u odnosu na preoperativne (p < 0,001). Poređenjem rezultata Mitchell-ovog i Golden-ovog postupka prema klasifikaciji po Bonney i McNab-u modifikovanoj po Hellal-u pokazano je da postoji visoko statistički značajna razlika u korist postupka po Mitchell-u (p < 0,001), a poređenjem na osnovu HMIS-a da nema statistički značajne razlike (p = 0,123). Analiza procene rezultata oba postupka na osnovu vrednosti hallus-valgus ugla, intermetatarzalnog ugla, pozicije sezamoida, dužine imobilizacije, trajanja lečenja i komplikacija pokazala je da postoji visoko statistički značajna razlika u korist postupka po Mitchell-u (p < 0,001), dok je procena vrednosti skraćenja prve metatarzalne kosti pokazala da je skraćenje izraženije kod postupka po Mitchell-u (p < 0,001), što ide u prilog Golden-ovoj metodi. U pogledu pokreta palca operisanih stopala nije postojala statistički značajna razlika (p = 0,723) između dva postupka. Zaključak. Oba postupka su pokazala dobre postoperativne rezultate. Poređenjem rezultata oba postupka došlo se do zaključka da su rezultati Mitchell-ovog postupka bolji u odnosu na Golden-ov postupak.

Reference

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Objavljeno
2021/02/10
Broj časopisa
Vol. 76 Br. 4 (2019): Vojnosanit pregl
Rubrika
Originalni članak