Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, Missouri, 14532 So. Outer Forty Drive, Chesterfield, MO 63017, USA.
Foot Ankle Int. 2010 Nov;31(11):973-9. doi: 10.3113/FAI.2010.0973.
Standard treatment of plantar first metatarsal head neuropathic ulceration with underlying osteomyelitis consists of extensive debridement of infected soft tissues and bone and often first ray amputation. The purpose of this study was to present a previously unreported, one stage, alternative to first ray amputation in patients with chronic first metatarsal head ulceration and associated chronic osteomyelitis.
A retrospective review was conducted of all patients that underwent one stage resection of the first metatarsophalangeal joint with pin stabilization for treatment of chronic plantar first metatarsal head ulceration with associated chronic osteomyelitis. The study included 15 patients (18 feet) who underwent 18 resections and stabilizations. All patients had a diagnosis of diabetic peripheral neuropathy, chronic plantar first metatarsal head ulceration of at least 3 months duration with exposed bone, and no gross purulence or acute cellulitis. Nine patients (60%) (11 feet) were available for followup telephone interviews. Four of the 15 (27%) (four feet) were deceased so they had medical record review only. The average followup was 48.8 months.
All ulcers healed with the exception of one foot (5%) who required a transmetatarsal amputation for worsening infection and wound complications. Three feet (17%) developed recurrent ulcerations. No foot had amputation of only the hallux or first ray.
This study presents a previously unreported, relatively simple, one stage treatment option for chronic first metatarsal head ulceration with underlying chronic osteomyelitis. This procedure allowed for successful healing of the ulcer while retaining the first ray.
患有足底第一跖骨头神经病理性溃疡伴骨髓炎的患者，其标准治疗方法包括广泛清创感染的软组织和骨骼，通常还需要进行第一跖骨截断术。本研究旨在介绍一种针对慢性第一跖骨头溃疡伴慢性骨髓炎患者的、以前未报道过的、替代第一跖骨截断术的一期治疗方法。
对所有接受第一跖趾关节切除和克氏针固定一期治疗的慢性足底第一跖骨头溃疡伴慢性骨髓炎的患者进行回顾性研究。该研究纳入了 15 例（18 足）接受 18 例切除和固定的患者。所有患者均被诊断为糖尿病周围神经病变，存在至少 3 个月的慢性足底第一跖骨头溃疡，且伴有暴露的骨骼，无明显脓性分泌物或急性蜂窝织炎。9 例患者（60%）（11 足）接受了随访电话访谈。15 例患者中有 4 例（27%）（4 足）死亡，仅进行了病历回顾。平均随访时间为 48.8 个月。
所有溃疡均愈合，除了 1 例（5%）因感染和伤口并发症恶化而需要行跖骨间截肢术的患者外。3 例（17%）出现复发性溃疡。没有足只进行了第一跖骨或第一跖骨截断术。
本研究提出了一种以前未报道过的、相对简单的一期治疗方法，适用于慢性第一跖骨头溃疡伴骨髓炎。该方法可成功治愈溃疡，同时保留第一跖骨。
