Uda Hirokazu, Sugawara Yasushi, Niu Atusi, Sarukawa Syunji
Department of Plastic and Reconstructive Surgery, Jichi Medical School, Tochigi, Japan.
Plast Reconstr Surg. 2002 Apr 15;109(5):1581-91. doi: 10.1097/00006534-200204150-00015.
The purposes of this study were to evaluate the results of the operative treatment of lateral ray polydactyly and to consider appropriate surgical procedures, especially focusing on the selection of the toe, lateral toe or medial toe, to be resected. Twenty-two patients with lateral ray polydactyly foot (25 individual feet) at an average of 71 months' follow-up were included in this study. Cases were classified morphologically into three types on the basis of Hirase's configuration. In addition, these types were divided into two subtypes, metatarsal and phalangeal, on the basis of radiographic evaluation of the level of duplication. The clinical evaluations of the reconstructed toe were performed, and these results were investigated according to their morphologic classification and excised toe group. The distinctive problem of medial toe excision is valgus deformity. Eight of 25 toes retained persistent valgus deformity, and all of these cases were in the medial toe excision group. On the other hand, a distinctive problem in lateral toe excision is postoperative pain. Two patients suffered from postoperative pain in phalangeal type cases in the lateral toe excision group, and the remaining medial toe had a medial protuberant middle phalanx. The pain occurred at that protuberant point. Based on their experiences, the authors created an algorithm for selection of the toe to be excised. In metatarsal type cases, from a functional perspective, the toe that has a radiographically dominant metatarsus should be retained. On the other hand, in phalangeal type cases, the authors give priority to shape rather than function, and they excise the morphologically smaller toe independent of the condition of the phalanx as viewed on radiography. If the medial toe and the lateral toe are approximately the same size, the authors excise the lateral toe to avoid valgus deformity. When the lateral toe has severe valgus deformity that seems unlikely to be correctable intraoperatively, the lateral toe should be considered for excision even if it is larger than the medial toe.
本研究的目的是评估外侧趾多指畸形的手术治疗结果，并考虑合适的手术方法，尤其着重于选择切除的趾头，即外侧趾或内侧趾。本研究纳入了22例患有外侧趾多指畸形足的患者（共25只足），平均随访71个月。根据平濑构型，病例在形态学上分为三种类型。此外，根据影像学评估的重复水平，这些类型又分为两个亚型，即跖骨型和趾骨型。对重建趾进行了临床评估，并根据其形态学分类和切除趾组对这些结果进行了研究。内侧趾切除的一个突出问题是外翻畸形。25只趾中有8只持续存在外翻畸形，所有这些病例均在内侧趾切除组。另一方面，外侧趾切除的一个突出问题是术后疼痛。外侧趾切除组的趾骨型病例中有2例患者遭受术后疼痛，其余的内侧趾有中节趾骨内侧突出。疼痛发生在那个突出点。基于他们的经验，作者创建了一种选择切除趾头的算法。在跖骨型病例中，从功能角度来看，应保留影像学上占优势的跖骨所对应的趾头。另一方面，在趾骨型病例中，作者优先考虑形状而非功能，并且不管影像学上趾骨的情况如何，切除形态较小的趾头。如果内侧趾和外侧趾大小大致相同，作者会切除外侧趾以避免外翻畸形。当外侧趾有严重的外翻畸形且术中似乎无法矫正时，即使外侧趾比内侧趾大，也应考虑切除外侧趾。
