Tuckahoe Orthopaedic Associates, Richmond, VA 23226, USA.
Foot Ankle Int. 2011 Mar;32(3):294-9. doi: 10.3113/FAI.2011.0294.
Instability of the second metatarsophalangeal (MTP) joint is relatively common, and although the anatomy of the joint has been well described and plantar plate pathology has been identified, little has been written about its exposure and repair. The goal of this study was to elucidate the necessary dissection to expose and potentially repair the lesions of the plantar plate through a dorsal approach.
Sequential dorsal dissection of the second MTP joint was carried out in eight cadaveric specimens. After each step, measurements were obtained using fluoroscopic imaging and digital photography to determine the amount of exposure of the plantar plate gained by each step.
Dorsal capsulotomy of the second MTP joint with collateral ligament release off of the proximal phalanx base, then combined with a subcapital oblique metatarsal osteotomy provided on average 8 and 8.5 mm of exposure of the plantar plate as measured by digital photography and fluoroscopy, respectively. Minimal exposure was gained by releasing the collateral ligaments from the metatarsal head or elevating the plantar plate off of the plantar metatarsal head.
Exposure of the plantar plate can be obtained by releasing the collateral ligaments off of the proximal phalanx and performing a subcapital oblique osteotomy.
Minimizing the risk of disrupting the blood supply to the metatarsal head may be possible by avoiding collateral ligament or plantar plate release.
第二跖趾关节（MTP）的不稳定性较为常见，尽管关节的解剖结构已得到充分描述，且已确定跖板存在病变，但对于其显露和修复方法的相关研究却很少。本研究旨在阐明通过背侧入路显露和潜在修复跖板病变所需的解剖结构。
在 8 具尸体标本中连续进行第二 MTP 关节的背侧解剖。在每个步骤之后，使用透视成像和数字摄影术获取测量值，以确定每个步骤获得的跖板显露量。
通过对近节趾骨基底的侧副韧带进行背侧囊切开术并同时进行骨干下斜向跖骨切开术，平均可获得 8 毫米和 8.5 毫米的跖板背侧显露，分别通过数字摄影术和透视术进行测量。从跖骨头部松解侧副韧带或抬高跖板至跖骨头部，可获得最小程度的显露。
通过从近节趾骨松解侧副韧带并进行骨干下斜向骨切开术，可获得跖板的显露。
通过避免侧副韧带或跖板松解，可能可以降低对跖骨头血供的破坏风险。
