Fuhrmann Renée A
Lehrstuhl für Orthopädie der Friedrich-Schiller-Universität Jena am Waldkrankenhaus Rudolf Elle, Jena.
Oper Orthop Traumatol. 2005 Jun;17(2):195-210. doi: 10.1007/s00064-005-1129-z.
Arthrodesis of the first tarsometatarsal joint for the treatment of a painful splayfoot with the aim to restore a normal weight bearing on the first ray. Correction of hallux valgus deformity.
Advanced splayfoot deformity with a first intermetatarsal angle > 18 degrees. Hypermobility of the first tarsometatarsal joint with reduced weight bearing on the first ray and development of a transfer metatarsalgia. Painful, primary or secondary osteoarthritis of the first tarsometatarsal joint. Recurrence of splayfoot deformity after previous attempt at surgical correction. Elevation of the first ray such as after developmental clubfoot. Metatarsus primus varus deformity accompanied by hallux valgus in the presence of a hypermobile flatfoot.
Minimal or moderate splayfoot deformity with a first intermetatarsal angle < 17 degrees and a clinically stable first tarsometatarsal joint. Untreated hindfoot deformities such as flatfoot combined with heel valgus. Inability to use walking aids for postoperative partial weight bearing. Insufficient circulation of forefoot.
Dorsomedial incision overlying the first tarsometatarsal joint. Splitting of the extensor aponeurosis medial to the tendon of the extensor hallucis longus. Subperiosteal exposure of the first tarsometatarsal joint. Opening of the joint. Judicious removal of articular cartilage and resection of a laterally based bony wedge from the medial cuneiform for correction of the increased first intermetatarsal angle. Manual correction of the splayfoot with concomitant plantar displacement of the base of the first metatarsal. Selection of properly fitting fixed-angle plate and internal fixation. Soft-tissue correction at the first metatarsophalangeal joint or metatarsal neck osteotomy to realign the articular surface of the first metatarsal head.
Clinical and radiologic results based on 56 patients (64 feet) followed up for an average of 8.2 months.
one reflex sympathetic dystrophy, four nonunions of the first tarsometatarsal joint (6.2%). Radiologic evidence of consolidation at a mean of 9 weeks. Improvement of the first intermetatarsal angle from 20.4 degrees to 11.2 degrees. Pressure measurement showed a significantly improved load-carrying capacity of the first ray. The score of the American Orthopaedic Foot and Ankle Society improved significantly (p < 0.01) from 51 to 92 points.
第一跖跗关节融合术用于治疗疼痛性扁平足，旨在恢复第一跖骨正常负重。矫正拇外翻畸形。
第一跖骨间角>18度的重度扁平足畸形。第一跖跗关节活动过度，第一跖骨负重减少并出现转移性跖骨痛。第一跖跗关节原发性或继发性疼痛性骨关节炎。先前手术矫正后扁平足畸形复发。发育性马蹄足等导致的第一跖骨抬高。伴有拇外翻的第一跖骨内翻畸形合并可活动扁平足。
第一跖骨间角<17度的轻度或中度扁平足畸形且第一跖跗关节临床稳定。未治疗的后足畸形，如扁平足合并足跟外翻。术后无法使用助行器进行部分负重。前足血液循环不足。
在第一跖跗关节上方做背内侧切口。在拇长伸肌腱内侧劈开伸肌腱膜。第一跖跗关节骨膜下暴露。打开关节。明智地去除关节软骨，并从内侧楔骨切除外侧基底的骨楔，以矫正增大的第一跖骨间角。手法矫正扁平足，同时将第一跖骨基底向足底移位。选择合适的固定角度钢板并进行内固定。在第一跖趾关节进行软组织矫正或跖骨颈截骨，以重新对齐第一跖骨头的关节面。
基于56例患者（64足）的临床和影像学结果，平均随访8.2个月。
1例反射性交感神经营养不良，4例第一跖跗关节不愈合（6.2%）。平均9周时有影像学愈合证据。第一跖骨间角从20.4度改善至11.2度。压力测量显示第一跖骨的负重能力显著提高。美国矫形足踝协会评分从51分显著提高至92分（p<0.01）。
