Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 8 Hakdong, Donggu, Gwangju, 501-757, South Korea.
J Bone Joint Surg Am. 2010 Nov 17;92(16):2709-18. doi: 10.2106/JBJS.I.00338.
Brachymetatarsia is the presence of an abnormally short metatarsal, and distraction osteogenesis has been used for its treatment. The purpose of the present study was to compare the outcomes of patients who underwent distraction osteogenesis for the treatment of first and/or fourth brachymetatarsia.
The data from forty-eight patients (sixty-four feet, seventy-four metatarsals) who underwent distraction osteogenesis for the treatment of brachymetatarsia were reviewed. The indications for surgery included a metatarsal that was at least 10 mm shorter than the adjacent metatarsal and that had an unacceptable cosmetic appearance. The study group comprised thirty-two first brachymetatarsia in nineteen patients (Group A) and forty-two fourth brachymetatarsia in twenty-nine patients (Group B). The average age was twenty years in Group A and eighteen years in Group B. The average duration of follow-up was 58.1 months in Group A and 56.1 in Group B. Metatarsal length, lengthening gain, healing time and index, and the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal and lesser metatarsophalangeal-interphalangeal scores were evaluated.
All patients were satisfied with the final length of the metatarsal and all had achieved bone union at the time of the last follow-up. The mean lengthening gain was 17.2 mm (42.9%) in Group A and 16.3 mm (37.3%) in Group B. The mean healing index was 71.0 days/cm in Group A and 67.3 days/cm in Group B. The mean American Orthopaedic Foot and Ankle Society score was 91.2 points in Group A and 92.8 points in Group B at the last follow-up (twenty-two excellent, nine good, and one fair results in Group A, and twenty-nine excellent, eleven good, and two fair results in Group B). The most common complication was metatarsophalangeal joint stiffness, which occurred in thirteen rays in Group A and in twelve rays in Group B; malalignment of the lengthened metatarsal was observed six times in each group. No significant intergroup differences in the outcomes were found.
Distraction osteogenesis for first and/or fourth brachymetatarsia provided successful lengthening of a metatarsal with eventual osseous union and was associated with similar outcomes in terms of healing index, function score, and the prevalence of complications between the two groups, although frequent complications were encountered and no improvement in foot function was found.
短趾畸形是指跖骨异常缩短，可采用牵张成骨术进行治疗。本研究旨在比较第一跖骨和/或第四跖骨短缩患者行牵张成骨术治疗的效果。
回顾了 48 例（64 足，74 跖骨）接受牵张成骨术治疗短趾畸形的患者资料。手术适应证包括跖骨比相邻跖骨短至少 10mm 且外观难以接受。研究组包括 19 例患者的 32 例第一跖骨短缩（A 组）和 29 例患者的 42 例第四跖骨短缩（B 组）。A 组患者平均年龄 20 岁，B 组 18 岁。A 组平均随访 58.1 个月，B 组 56.1 个月。评估了跖骨长度、延长增益、愈合时间和指数以及美国矫形足踝协会（American Orthopaedic Foot and Ankle Society）大踇趾跖趾关节-趾间关节和小趾跖趾关节-趾间关节评分。
所有患者均对跖骨最终长度满意，末次随访时所有患者均获得骨性愈合。A 组平均延长增益为 17.2mm（42.9%），B 组为 16.3mm（37.3%）。A 组平均愈合指数为 71.0 天/cm，B 组为 67.3 天/cm。末次随访时，A 组美国矫形足踝协会评分为 91.2 分，B 组为 92.8 分（A 组 22 例优，9 例良，1 例可；B 组 29 例优，11 例良，2 例可）。最常见的并发症是跖趾关节僵硬，A 组 13 个射线，B 组 12 个射线；两组各有 6 次出现延长跖骨对线不良。两组间在结果方面无显著差异。
第一跖骨和/或第四跖骨短缩行牵张成骨术可成功延长跖骨，最终获得骨性愈合，两组间愈合指数、功能评分和并发症发生率相似，但并发症发生率较高，且未改善足部功能。
