Lee W-C, Yoo J H, Moon J-S
Department of Orthopaedic Surgery, Seoul Paik Hospital, College of Medicine, Inje University, 85, 2-ga, Jeo-dong, Jung-Gu, Seoul 100-032, Korea.
J Bone Joint Surg Br. 2009 Nov;91(11):1472-7. doi: 10.1302/0301-620X.91B11.22169.
We carried out a retrospective study to assess the clinical results of lengthening the fourth metatarsal in brachymetatarsia in 153 feet of 106 patients (100 female, six males) using three different surgical techniques. In one group lengthening was performed by one-stage intercalary bone grafting secured by an intramedullary Kirschner-wire (45 feet, 35 patients). In the second group lengthening was obtained gradually using a mini-external fixator after performing an osteotomy with a saw (59 feet, 39 patients) and in the third group lengthening was achieved in a gradual manner using a mini-external fixator after undertaking an osteotomy using osteotome through pre-drilled holes (49 feet, 32 patients). The mean age of the patients was 26.3 years (13 to 48). Pre-operatively, the fourth ray of the bone-graft group was longer than that of other two groups (p < 0.000). The clinical outcome was compared in the three groups. The mean follow-up was 22 months (7 to 55). At final follow-up, the mean lengthening in the bone-graft group was 13.9 mm (3.5 to 23.0, 27.1%) which was less than that obtained in the saw group with a mean of 17.8 mm (7.0 to 33.0, 29.9%) and in the pre-drilled osteotome group with a mean of 16.8 mm (6.5 to 28.0, 29.4%, p = 0.001). However, the mean time required for retention of the fixation in the bone-graft group was the shortest of the three groups. Patients were dissatisfied with the result for five feet (11.1%) in the bone-graft group, eight (13.6%) in the saw group and none in the pre-drilled osteotomy group (p < 0.000). The saw group included eight feet with failure of bone formation after surgery. Additional operations were performed in 20 feet because of stiffness (n = 7, all groups), failure of bone formation (n = 4, saw group), skin maceration (n = 4, bone-graft group), malunion (n = 4, bone-graft and saw groups) and breakage of the external fixator (n = 1, saw group). We conclude that the gradual lengthening by distraction osteogenesis after osteotomy using an osteotome produces the most reliable results for the treatment of fourth brachymetatarsia.
我们进行了一项回顾性研究，以评估采用三种不同手术技术对106例患者（100例女性，6例男性）的153只脚进行短跖骨第四跖骨延长的临床效果。在一组中，通过髓内克氏针固定的一期嵌入植骨进行延长（45只脚，35例患者）。在第二组中，使用锯进行截骨术后，通过微型外固定器逐渐实现延长（59只脚，39例患者），在第三组中，通过骨凿在预钻孔后进行截骨术，再使用微型外固定器逐渐实现延长（49只脚，32例患者）。患者的平均年龄为26.3岁（13至48岁）。术前，植骨组的第四跖骨比其他两组更长（p<0.000）。对三组的临床结果进行了比较。平均随访时间为22个月（7至55个月）。在最终随访时，植骨组的平均延长长度为13.9毫米（3.5至23.0，27.1%），低于锯组的平均17.8毫米（7.0至33.0，29.9%）和预钻孔骨凿组的平均16.8毫米（6.5至28.0，29.4%，p=0.001）。然而，植骨组固定保留所需的平均时间是三组中最短的。植骨组有5只脚（11.1%）、锯组有8只脚（13.6%）的患者对结果不满意，预钻孔截骨组无一例（p<0.000）。锯组中有8只脚术后骨形成失败。由于僵硬（n=7，所有组）、骨形成失败（n=4，锯组）、皮肤浸渍（n=4，植骨组）、畸形愈合（n=4，植骨组和锯组）以及外固定器断裂（n=1，锯组），20只脚进行了额外手术。我们得出结论，使用骨凿截骨后通过牵张成骨逐渐延长对于治疗第四跖骨短小症产生最可靠的结果。
