在尸体模型中，第一跖骨缩短和背屈截骨术对前足足底压力的影响。

Effect of first metatarsal shortening and dorsiflexion osteotomies on forefoot plantar pressure in a cadaver model.

作者信息

Jung Hung-Geun, Zaret David I, Parks Brent G, Schon Lew C

机构信息

Department of Orthopaedic Surgery, Dankook University Medical Center, Cheonan, South Korea.

出版信息

Foot Ankle Int. 2005 Sep;26(9):748-53. doi: 10.1177/107110070502600913.

DOI:10.1177/107110070502600913

PMID:16174506

Abstract

BACKGROUND

Metatarsalgia of the second ray is a common problem associated with disorders of the first metatarsal. It also occurs after the operative treatment of those disorders. Plantar pressure changes from alteration of the static and dynamic structure of the forefoot may be associated with this condition. This study evaluated changes in plantar forefoot pressure especially under the second metatarsal head after three operative procedures on the first ray.

METHODS

Each of 12 cadaver foot specimens was cyclically loaded on the servohydraulic MTS Mini Bionix test frame (MTS Systems Corp., Eden Prairie, MN) with traction on the Achilles tendon. Plantar forefoot pressure was measured by the F-scan system (Tekscan, Inc., S. Boston, MA) with the foot intact, after a first metatarsal base dorsal closing-wedge osteotomy with 5-mm base length to simulate dorsal malunion, and after 5-mm and 10-mm metatarsal shortening procedures. Paired Student t-test analysis was used to compare data for the intact foot with data after each intervention. One form of Bonferroni's correction was done to establish a new alpha level to tighten the analysis and to compensate for multiple paired Student t-tests. The significance level was calculated to be 0.016 based on an original alpha level of 0.05.

RESULTS

As compared with the intact foot, all three procedures on the first metatarsal resulted in significant decreases in plantar pressure under the first metatarsal head (p < 0.016). Plantar pressure under the second metatarsal head increased significantly as compared with the intact foot (p < 0.016) after all three procedures. Pressures under the third-fourth metatarsal heads increased significantly compared with the intact foot after the 5-mm and 10-mm shortenings (p < 0.016). Plantar pressure under the fifth metatarsal did not change significantly after any of the three procedures.

CONCLUSIONS

Dorsiflexion osteotomy and shortening of the first metatarsal are associated with significant forefoot plantar pressure changes in a cadaver model.

摘要

背景

第二跖骨痛是与第一跖骨疾病相关的常见问题。它也发生在这些疾病的手术治疗之后。前足静态和动态结构改变引起的足底压力变化可能与这种情况有关。本研究评估了第一跖骨的三种手术操作后前足底压力的变化，尤其是第二跖骨头下方的压力变化。

方法

12个尸体足标本中的每一个都在伺服液压MTS Mini Bionix测试框架（MTS Systems Corp.，伊登草原，明尼苏达州）上进行循环加载，并对跟腱施加牵引力。在足部完整时、模拟背侧畸形愈合进行5毫米基底长度的第一跖骨基底背侧闭合楔形截骨术后以及5毫米和10毫米跖骨缩短术后，通过F-scan系统（Tekscan，Inc.，南波士顿，马萨诸塞州）测量前足底压力。采用配对学生t检验分析将完整足部的数据与每次干预后的数据进行比较。采用一种形式的Bonferroni校正来建立新的α水平，以加强分析并补偿多次配对学生t检验。基于原始α水平0.05计算得出的显著性水平为0.016。

结果

与完整足部相比，第一跖骨的所有三种手术操作均导致第一跖骨头下方的足底压力显著降低（p < 0.016）。在所有三种手术操作后，与完整足部相比，第二跖骨头下方的足底压力显著增加（p < 0.016）。在进行5毫米和10毫米缩短术后，与完整足部相比，第三和第四跖骨头下方的压力显著增加（p < 0.016）。在三种手术操作中的任何一种之后，第五跖骨下方的足底压力均未发生显著变化。