Erdem Mehmet, Sen Cengiz, Eralp Levent, Kocaoğlu Mehmet, Ozden Vahit
Orthopedics and Traumatology, Gaziosmanpasa University, Gaziosmanpasa Universitesi Tip Fakultesi, Ortopedi ve Travmatoloji Anabilim Dali, Tokat, Turkey.
Int Orthop. 2009 Jun;33(3):807-13. doi: 10.1007/s00264-007-0491-x. Epub 2007 Dec 19.
We performed bone lengthening surgery on 12 metacarpals and 14 metatarsals of 15 patients. The mean age for metacarpal and metatarsal lengthening was 14.5 (10-21) and 17.5 (10-25) years, respectively. We used a unilateral or a circular external fixator. The mean healing index of the metacarpals and metatarsals was 1.6 (1.1-2.3) and 1.6 (1.0-2.0) months/cm, respectively. The mean increase in metacarpal and metatarsal length was 17.6 (13-26) and 24.3 (20-30) mm, respectively. The functional scores of the metatarso-phalangial (MTP) joint of lengthened metatarsals for the lesser toe were excellent in 12 and good in two cases based on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. Complications were seen in six of the metatarsal lengthening cases including four angulations, one subluxation and one non-union. We conclude that the periosteum must be protected with percutaneous osteotomy and lengthening should be performed at a rate of 0.25 mm twice a day and should not exceed 40% of the original bone length (or >20 mm).
我们对15例患者的12根掌骨和14根跖骨进行了骨延长手术。掌骨和跖骨延长的平均年龄分别为14.5（10 - 21）岁和17.5（10 - 25）岁。我们使用了单侧或环形外固定器。掌骨和跖骨的平均愈合指数分别为1.6（1.1 - 2.3）个月/厘米和1.6（1.0 - 2.0）个月/厘米。掌骨和跖骨长度的平均增加量分别为17.6（13 - 26）毫米和24.3（20 - 30）毫米。根据美国矫形足踝协会（AOFAS）评分系统，延长跖骨的小趾跖趾（MTP）关节功能评分，12例为优，2例为良。跖骨延长病例中有6例出现并发症，包括4例成角、1例半脱位和1例骨不连。我们得出结论，必须采用经皮截骨术保护骨膜，延长速率应为每天两次，每次0.25毫米，且不应超过原骨长度的40%（或>20毫米）。
