Haddad S L, Sabbagh R C, Resch S, Myerson B, Myerson M S
Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, Maryland, USA.
Foot Ankle Int. 1999 Dec;20(12):781-8. doi: 10.1177/107110079902001205.
Between 1990 and 1995, 38 patients (42 feet) underwent repair for crossover toe deformity, 31 (35 feet) of whom returned for final examination at an average of 51.6 months (range, 24-81 months). Causes included trauma, iatrogenic, and unknown. Presenting complaints included dorsal pain with either metatarsalgia or joint pain, isolated metatarsophalangeal (MP) joint pain, metatarsalgia, painful plantar callus, metatarsalgia and joint pain, and painful dorsal callus. All patients were treated with one of two operative techniques, either the flexor-to-extensor tendon transfer or the extensor brevis tendon transfer. Choice of procedure depended on the stage of preoperative deformity. Twenty-four patients were completely satisfied with the surgical correction, 6 were satisfied with reservations, and 1 was dissatisfied. The average postoperative AOFAS score for all patients was 85 points (range, 54-100 points), which correlated strongly with patient satisfaction. Twenty-two patients stated that they had no postoperative pain, 8 reported some pain, and 1 had frequent pain at the corrected toe. In 30 feet, there was no recurrence; three patients had mild residual crossover toe deformity, and two patients had recurrent deformity, although all MP joints were stable. Follow-up radiographs demonstrated substantial reduction in MP joint angles in both the AP (from 7 degrees to -1 degree) and lateral (from 45 degrees to 25 degrees) projections. This article reviews the surgical technique of both procedures, proposes specific indications for each, and presents outcomes. Based on our findings, the extensor brevis tendon transfer is appropriate for stage 1, stage 2, and flexible stage 3 deformities. Flexor-to-extensor tendon transfer is appropriate for rigid stage 3 and stage 4 deformities and for all patients with a symptomatic neuroma of the second web space (where the extensor brevis transfer is not possible). Stiffness of the MP joint is a potential problem with the flexor-to-extensor tendon transfer.
1990年至1995年间，38例（42足）患者接受了交叉趾畸形修复手术，其中31例（35足）患者平均在51.6个月（范围24 - 81个月）后返回接受最终检查。病因包括创伤、医源性及不明原因。主要症状包括伴有跖痛或关节疼痛的背侧疼痛、孤立的跖趾（MP）关节疼痛、跖痛、疼痛性足底胼胝、跖痛和关节疼痛以及疼痛性背侧胼胝。所有患者均采用两种手术技术之一进行治疗，即屈肌腱转位至伸肌腱或短伸肌腱转位。手术方式的选择取决于术前畸形的阶段。24例患者对手术矫正完全满意，6例基本满意，1例不满意。所有患者术后AOFAS平均评分为85分（范围为54 - 100分），与患者满意度密切相关。22例患者表示术后无疼痛，8例报告有一些疼痛，1例矫正趾频繁疼痛。30足无复发；3例患者有轻度残余交叉趾畸形，2例患者有畸形复发，尽管所有MP关节均稳定。随访X线片显示MP关节在前后位（从7°降至 - 1°）和侧位（从45°降至25°）投影中的角度均显著减小。本文回顾了两种手术的技术，提出了各自的具体适应证，并展示了治疗结果。根据我们的研究结果，短伸肌腱转位适用于1期、2期和可屈性3期畸形。屈肌腱转位至伸肌腱适用于僵硬性3期和4期畸形以及所有第二趾蹼间隙有症状性神经瘤的患者（无法进行短伸肌腱转位时）。MP关节僵硬是屈肌腱转位至伸肌腱手术的一个潜在问题。
