변형 마우 절골 술기의 유용성과 한계점 (30예 추시 보고) = The Value and Limitation of the Modified Mau Osteotomy (30 Cases Follow Up Report)

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the value and limitation of modified Mau osteotomy through the review of 30 feet treated by this procedure. Materials and Methods: We retrospectively analyzed 30 cases treated with modified Mau osteotomy since 2002. The mean duration of follow-up was 10 months. We reviewed medical records to describe each case and select several clinical factors which related with surgical procedure and could influence on final results. We measured radiographic parameters such as hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position and also assessed clinical outcomes by AOFAS score and satisfaction degrees. Results: The mean preoperative HVA and IMA were $40.4^{\circ}$, $17.4^{\circ}$ and the mean amounts of correction were $31.2^{\circ}$ and $11.5^{\circ}$. Amounts of delayed loss of correction were 16.8% in HVA and 19.2% in IMA. Initial HVA, rotational angle and translation distance of the distal fragment, stability of fixation, first ray instability were revealed as significant factors for the final result from this procedure. DMAA was increased by rotation of the distal fragment and decreased by adding translation on the rotation. Conclusion: Modified Mau osteotomy is an effective procedure to get enough correction. But, it is important to try to avoid excessive rotation of the distal fragment because it may worse joint congruity. It may be worthwhile to pay close attention to the direction of saw and stability of fixation.

참고문헌 (Reference)

1 Coughlin MJ, "Treatment of hallux valgus with an increased distal metatarsal articular angle: evaluation of double and triple first ray osteotomies" 20 : 762-770, 1999

2 Shereff MJ, "The stability of fixation of first metatarsal osteotomies" 11 : 208-211, 1991

3 Cohen MM, "The oblique proximal phalangeal osteotomy in the correction of hallux valgus" 42 : 282-289, 2003

4 Pinney S, "Surgical treatment of mild hallux valgus deformity: the state of practice among academic foot and ankle surgeons" 27 : 970-973, 2006

5 Coughlin MJ, "Roger A. Mann Award. Juvenile hallux valgus: etiology and treatment" 16 : 682-697, 1995

6 Moon HT, "Results of Ludloff osteotomy in hallux valgus" 9 : 64-68, 2005

7 Nyska M, "Proximal metatarsal osteotomies: a comparative geometric analysis conducted on sawbone models" 23 : 938-945, 2002

8 Jones C, "Proximal crescentic metatarsal osteotomy: the effect of saw blade orientation on first ray elevation" 26 : 152-157, 2005

9 Park HS, "Operative treatment for hallux valgus with proximal metatarsal osteotomy in patients over 55 years old" 9 : 69-73, 2005

10 Bae SY, "Modified Mau osteotomy for the treatment of severe hallux valgus" 8 : 117-120, 2004

11 Acevedo JI, "Mechanical comparison of cyclic loading in five different first metatarsal shaft osteotomies" 23 : 711-716, 2002

12 Haas Z, "Maintenance of correction of first metatarsal closingbase wedge osteotomies versus modified Lapidus arthrodesis for moderate to severe hallux valgus deformity" 46 : 358-365, 2007

13 Frey C, "Jahss M and Kummer FJ: The Akin procedure: an analysis of results" 12 : 1-6, 1991

14 Bonnel F, "Evaluation of the Scarf osteotomy in hallux valgus related to distal metatarsal articular angle: a prospective study of 79 operated cases" 84 : 381-386, 1999

15 Lau JT, "Effect of increasing distal medial closing wedge metatarsal osteotomies on the distal metatarsal articular angle" 20 : 771-776, 1999

16 Lippert FG, "Crescentic osteotomy for hallux valgus: a biomechanical study of variables affecting the final position of the first metatarsal" 11 : 204-207, 1991

17 Sammarco GJ, "Complications after surgery of the hallux" 391 : 59-71, 2001

18 Nery C, "Biplanar chevron osteotomy" 23 : 792-798, 2002

19 Hofstaetter SG, "Biomechanical comparison of screws and plates for hallux valgus opening-wedge and Ludloff osteotomies" 23 : 101-108, 2008

20 Scranton PE, "Anatomic variations in the first ray: part I. Anatomic aspects related to bunion surgery" 151 : 244-255, 1980