Background: 

Patients who have noninflammatory arthritis of the feet may develop destructive changes on the first metatarsal head and painful dislocation of the metatarsophalangeal (MTP) joint of 1 or more lesser toes. This aim of this study was to compare feet with noninflammatory arthritis and those with rheumatoid arthritis (RA) with respect to the clinical and radiographic outcomes after treatment of these destructive deformities with a modified Scarf osteotomy with medial capsular interposition into the newly formed first MTP joint, combined with metatarsal shortening offset osteotomy.

Methods: 

A retrospective observational study of 93 feet (31 with noninflammatory arthritis and 62 with RA) was performed. Hallux and lesser-toe scores on the Japanese Society for Surgery of the Foot (JSSF) scoring system, a self-administered foot evaluation questionnaire (SAFE-Q), and preoperative and postoperative radiographic parameters were evaluated.

Results: 

There were significant improvements at the time of the final follow-up in the mean scores on the hallux and lesser-toe scales of the JSSF system and in the SAFE-Q score. The postoperative JSSF lesser-toes function score was better for the feet with noninflammatory arthritis feet than the feet with RA. There was no significant difference in the hallux valgus angle (HVA) between 1 month postoperatively and the final follow-up for both groups. Furthermore, the HVA showed a strong correlation between the 1-month and final follow-up values.

Conclusions: 

The combination of the modified Scarf osteotomy with medial capsular interposition and shortening metatarsal offset osteotomy was useful and safe in feet with noninflammatory arthritis. The HVA at 1 month after surgery is useful to predict the HVA within 5 years after surgery. The postoperative clinical score for the lesser toes was better in the feet with noninflammatory arthritis.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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改良围巾截骨内侧包膜结合跖骨缩短偏移截骨术：非炎性关节炎和类风湿性关节炎患者的比较

背景： 

患有足部非炎性关节炎的患者可能会出现第一跖骨头的破坏性变化和一个或多个小脚趾的跖趾（MTP）关节疼痛脱位。本研究的目的是比较患有非炎症性关节炎和类风湿性关节炎 (RA) 的足部在使用改良的 Scarf 截骨术治疗这些破坏性畸形后的临床和影像学结果，内侧关节囊插入新形成的第一个 MTP 关节，结合跖骨缩短偏移截骨术。

方法： 

对 93 只脚（31 只患有非炎症性关节炎，62 只患有 RA）进行了一项回顾性观察研究。对日本足部外科学会 (JSSF) 评分系统的拇趾和小脚趾评分、自我管理的足部评估问卷 (SAFE-Q) 以及术前和术后影像学参数进行了评估。

结果： 

在最终随访时，JSSF 系统的拇趾和小脚趾量表的平均得分以及 SAFE-Q 得分有显着改善。非炎症性关节炎足的术后 JSSF 小脚趾功能评分优于 RA 足。两组术后1个月与末次随访的拇外翻角（HVA）无显着差异。此外，HVA 显示出 1 个月和最终随访值之间的强相关性。

结论： 

改良的 Scarf 截骨术与内侧关节囊插入和缩短跖骨偏移截骨术的组合对患有非炎症性关节炎的足部是有用且安全的。术后 1 个月的 HVA 有助于预测术后 5 年内的 HVA。非炎症性关节炎足部小脚趾的术后临床评分更好。

证据等级： 

治疗级别 IV。有关证据级别的完整描述，请参见作者说明。