Galluch David B, Bohay Donald R, Anderson John G
Medical Education Office, 200 Jefferson Avenue, Grand Rapids, MI 49503, USA.
Foot Ankle Int. 2007 Feb;28(2):169-74. doi: 10.3113/FAI.2007.0169.
Metatarsalgia is a common source of patient discomfort and has multiple etiologies. Lesser metatarsal osteotomy is a recognized treatment modality for persistent symptoms after conservative care, yet the location and type of osteotomy remain highly debated topics. The current investigation reports the initial results regarding midshaft, segmental osteotomy of the lesser metatarsals with open reduction and internal fixation.
Ninety-five consecutive patients had lesser metatarsal midshaft, segmental osteotomy with open reduction and internal fixation from June, 1999, to October, 2001, representing 102 feet and 126 osteotomies. Patient records were retrospectively reviewed for osteotomy union, symptomatic relief, and complications associated with this procedure. Followup ranged from 5 months to 18 months with an average of 8.8 months. Fixation was achieved with a four-hole, 1/4-tubular, minifragment, plate and four 2.7-mm cortical screws.
Five patients had transfer lesions, (five feet, five osteotomies) within the followup period. One patient (one foot, one osteotomy, 0.8%) developed a nonunion. After hardware removal this patient's osteotomy united. This technique produced excellent metatarsal union rates (125 of 126 osteotomies, 99.2%).
Although further clinical investigation regarding patient outcome from this procedure needs to be carried out, the data from this preliminary study indicate that midshaft segmental osteotomy of a lesser metatarsal is a useful technique for metatarsal shortening with a high rate of bony union.
跖痛症是患者不适的常见原因，有多种病因。小趾跖骨截骨术是保守治疗后持续症状的一种公认治疗方式，但截骨的位置和类型仍是备受争议的话题。本研究报告了小趾跖骨中段节段性截骨并切开复位内固定的初步结果。
1999年6月至2001年10月，95例连续患者接受了小趾跖骨中段节段性截骨并切开复位内固定，共102足，126处截骨。回顾性分析患者记录，了解截骨愈合情况、症状缓解情况以及与该手术相关的并发症。随访时间为5个月至18个月，平均8.8个月。采用四孔1/4管状微型接骨板和4枚2.7毫米皮质骨螺钉进行固定。
5例患者（5足，5处截骨）在随访期间出现转移性病变。1例患者（1足，1处截骨，0.8%）发生骨不连。取出内固定后，该患者的截骨愈合。该技术的跖骨愈合率极佳（126处截骨中有125处，99.2%）。
虽然需要对该手术患者的预后进行进一步的临床研究，但这项初步研究的数据表明，小趾跖骨中段节段性截骨术是一种用于跖骨缩短且骨愈合率高的有效技术。
