Objective To compare the efficacy of the fourth-generation minimally invasive technique—minimally invasive extra-articular metaphyseal distal transverse osteotomy (META) and Chevron osteotomy (minimally invasive Chevron and Akin osteotomy, MICA) in treatment of hallux valgus. Methods A total of 80 patients with hallux valgus who underwent single-foot surgery between July 2023 and January 2025and met the inclusion criteria, were included in the study. Among them, 40 patients were treated with META and 40 with MICA. There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, height, weight, body mass index, disease duration, lesion site, hallux valgus deformity degree, as well as preoperative scores of each item in the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale (AOFAS-Hallux-MTP-IP), scores of each item in the Manchester-Oxford Foot Questionnaire (MOXFQ), hallux valgus angle (HVA), the intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, and the 1st metatarsal head morphology. The postoperative AOFAS-Hallux-MTP-IP scores (pain, function, alignment, total score), MOXFQ scores (pain, walking/standing, social interaction, total score), as well as HVA, IMA, DMAA, the 1st metatarsal head morphology, and sesamoid position measured based on weight-bearing foot X-ray films were compared between the two groups; the occurrence of postoperative complications was recorded. Results All patients in both groups were followed up 6-18 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). At last follow-up, the scores of all items in AOFAS-Hallux-MTP-IP in both groups were higher than those before operation, and the scores of all items in MOXFQ were lower than those before operation, with significant differences (P<0.05); there was no significant difference in the change values of all item scores in MOXFQ between the two groups (P>0.05). The change value in AOFAS function score in the META group was significantly higher than that in the MICA group (P<0.05), while there was no significant difference in the change value of AOFAS pain score, alignment score, and total score between the two groups (P>0.05). After operation, 1 case (2.5%) of superficial incision infection and 2 cases (5.0%) of numbness around the incision occurred in the MICA group, while only 2 cases (5.0%) of numbness around the incision occurred in the META group. Imaging reexamination showed that HVA, IMA, and DMAA in both groups were signifncatly smaller than those before operation (P<0.05), and there was no significant difference in the change values of the above angles between the two groups (P>0.05). The 1 st metatarsal head morphology and sesamoid position in the META group were better than those in the MICA group after operation, with significant differences (P<0.05). Conclusion Both META and MICA can correct hallux valgus deformity, improve foot function, and relieve pain, but META has more advantages in correcting metatarsal rotation and reducing dislocated sesamoids.
Objective To explore the role and possible mechanisms of bone marrow mesenchymal stem cell (BMSC) in the lipopolysaccharide (LPS)-induced inflammatory response involving alveolar macrophages through the inflammatory pathways. Methods ptges and ptges shRNA were transfected into BMSC by lentivirus, and stable ptges overexpression BMSC (BMSC-PGE2(+)) and PTGEs silencing BMSC (BMSC-PGE2(-)) were established. Macrophages were divided into control group, LPS group, LPS+BMSC group, LPS+BMSC-PGE2(+) group and LPS+BMSC-PGE2(-) group. The expression levels of nucleotide-bound oligomerized domain-like receptor 3 (NLRP3), precursor cysteinyl aspartate specific proteinase 1 (pro-caspase-1), caspase-1 and pro-IL-1β proteins were detected by Western blot. The mRNA expression levels of NLRP3 and caspase-1 were determined by RT-PCR. The expression levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-10, IL-18 and prostaglandin E2 (PGE2) in cell supernatant were detected by ELISA. Results The intervention of LPS significantly increased the expression of NLRP3, pro-caspase-1, caspase-1 and pro-IL-1β in macrophages. After co-culture with BMSC, the expression of each protein decreased significantly. After the overexpression of PGE2, the difference of protein expression further decreased. The expression of NLRP3 and caspase-1 mRNA in LPS group increased significantly, but decreased significantly after co-culture with BMSC. Overexpression of PGE2 could increase this difference, but there was no significant change in PGE2 silent group. The results of ELISA showed that the contents of TNF-α, IL-1β and IL-18 in cell supernatant were the highest in LPS group. Adding BMSC and overexpressing PGE2 could decrease the related inflammatory factors. The levels of IL-10 and PGE2 in LPS group were higher than those in control group, and further increased in LPS+BMSC group and LPS+BMSC-PGE2(+) group with significant differences. Conclusions When inflammation is induced by LPS, BMSC can significantly mitigate the inflammatory response within macrophages. This process is likely mediated through the overexpression of PGE2, which inhibits the NLRP3-mediated pyroptosis pathway.