Yong Su Mei, Smith Peter A, Kuo Ken N
Hospital Selayang, Selangor Darul Ehsan, Malaysia.
J Pediatr Orthop. 2007 Oct-Nov;27(7):814-20. doi: 10.1097/BPO.0b013e3181558a37.
The dorsal bunion deformity consists of the elevation of first metatarsal head, plantar flexion contracture at the first metatarsophalangeal joint, and dorsiflexion contracture of the tarsometatarsal joint. A reverse Jones procedure with transfer of the flexor hallucis longus to the metatarsal head has been an effective method in correcting this deformity.
This is a retrospective review of 27 patients with 33 feet who had reverse Jones procedure with or without metatarsal osteotomy between 1983 and 2002. All patients had previous soft tissue releases for clubfoot deformity. Clinical reviews included muscle function test and radiographic evaluation before and after procedures. We used the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-interphalangeal scale for functional outcome results.
The average follow-up was 4.96 years. There were 21 boys and 6 girls. Average age at time of procedure was 13.7 years. With the reverse Jones procedure, there were 18 first metatarsal osteotomies and 12 split anterior tibial tendon transfers. Before surgery, decreased muscle strength in triceps surae (73%), tibialis posterior (76%), peroneus longus (67%), and extensor hallucis longus (76%) was noted. Patients (84.9%) had normal tibialis anterior and flexor hallucis longus power. In radiographic evaluations, the operation resulted in decreased elevation of the first metatarsal by measuring the metatarsal-horizontal angle. The lateral metatarsophalangeal angle improved from 23 degrees plantar flexion to 1 degree in dorsiflexion. The average global American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-interphalangeal score was 70 preoperatively and 92 postoperatively with improvement of subscores in pain, activity, footwear, range of motion, callus, and alignment.
Dorsal bunion is a recognized long-term complication after clubfoot surgery. The causes of the deformity are weakness of Achilles tendon, overpowering of flexor hallucis longus, and strong anterior tibial tendon with weakness of peroneus longus. The reverse Jones procedure improved the condition in this series and provided a long-lasting and effective correction of the dorsal bunion deformity.
Level 4.
背侧拇囊炎畸形包括第一跖骨头抬高、第一跖趾关节跖屈挛缩以及跗跖关节背屈挛缩。将拇长屈肌转移至跖骨头的改良琼斯手术是矫正该畸形的有效方法。
这是一项对1983年至2002年间接受改良琼斯手术（伴或不伴跖骨截骨术）的27例患者（33足）的回顾性研究。所有患者既往均因马蹄内翻足畸形接受过软组织松解术。临床评估包括术前和术后的肌肉功能测试及影像学评估。我们使用美国矫形足踝协会拇趾跖趾-趾间关节评分系统来评估功能结果。
平均随访4.96年。其中男性21例，女性6例。手术时的平均年龄为13.7岁。改良琼斯手术中，有18例进行了第一跖骨截骨术，12例进行了胫前肌腱劈开转移术。术前，发现腓肠肌三头肌（73%）、胫后肌（76%）、腓骨长肌（67%）和拇长伸肌（76%）肌力下降。患者（84.9%）胫前肌和拇长屈肌力量正常。影像学评估显示，通过测量跖骨-水平角，手术使第一跖骨抬高程度降低。外侧跖趾关节角从跖屈23度改善为背屈1度。美国矫形足踝协会拇趾跖趾-趾间关节评分系统的总体平均评分术前为70分，术后为92分，疼痛、活动、鞋具、活动范围、胼胝及对线等分项评分均有所改善。
背侧拇囊炎是马蹄内翻足手术后公认的远期并发症。畸形的原因是跟腱无力、拇长屈肌力量过强、胫前肌腱有力而腓骨长肌无力。改良琼斯手术改善了本系列患者的病情，为背侧拇囊炎畸形提供了持久有效的矫正。
4级。
