Université de Lyon, Lyon, France.
Orthop Traumatol Surg Res. 2011 Oct;97(6 Suppl):S57-65. doi: 10.1016/j.otsr.2011.07.003. Epub 2011 Aug 27.
A Weil osteotomy with internal fixation can match the preoperative plan by precisely setting the metatarsal length; however 10 to 30% of patients end up experiencing postoperative stiffness. A percutaneous distal metatarsal mini-invasive osteotomy (DMMO) is a purely extra-articular technique; metatarsal length is set automatically upon weight bearing of the foot. The goal of this study was to compare these two osteotomy techniques when performed on the three or four most lateral metatarsals.
A DMMO will result in better joint motion than a Weil osteotomy.
This was a retrospective, single center, single surgeon study with 72 patients. Group 1 consisted of 39 patients operated by the DMMO technique. Group 2 consisted of 33 patients operated by the standard Weil osteotomy technique. In some cases, a procedure on the first ray (Scarf or fusion) was also performed. The age, gender and procedures on the first ray were comparable for both groups. Patients were evaluated with clinical (AOFAS score) and radiological outcomes (Maestro criteria) at 3 and 12 months minimum follow-up.
Sixty-seven patients were seen again with an average follow-up of 14.8 months (range 12-24). The postoperative AOFAS score was comparable in both groups (86.5 and 85.3, respectively). The joint range of motion was comparable in both groups. Static problems (oedema, metatarsalgia, hyperkeratosis and dislocation) were comparable at the last follow-up. The metatarsalgia recurred in four patients from group 1 and five patients from group 2. After 3 months, oedema and metatarsalgia were significantly greater in group 1. Radiological measurements (M1P1angle, M1M2angle and Maestro criteria) were comparable. Metatarsal head recoil was identical between each ray in group 1. At the last follow-up, all the osteotomy sites had achieved union.
The results of static metatarsalgia treatment were comparable when using a DMMO or Weil osteotomy. However the DMMO had longer postoperative recovery, notably because of oedema. The percutaneous DMMO technique did not improve joint range of motion.
III, comparative retrospective study.
通过精确设置跖骨长度，Weil 截骨术加内固定可与术前计划相匹配；然而，仍有 10%至 30%的患者术后出现僵硬。经皮远节跖骨微创截骨术（DMMO）是一种纯粹的关节外技术；当足部承重时，跖骨长度自动设置。本研究的目的是比较这两种截骨技术在最外侧的三或四个跖骨上的应用效果。
DMMO 会比 Weil 截骨术产生更好的关节活动度。
这是一项回顾性、单中心、单外科医生研究，共纳入 72 名患者。第 1 组由 39 名接受 DMMO 技术治疗的患者组成。第 2 组由 33 名接受标准 Weil 截骨术治疗的患者组成。在某些情况下，还对第一跖骨（Scarf 或融合）进行了手术。两组的年龄、性别和第一跖骨的手术情况相当。在至少 3 个月的随访中，通过临床（AOFAS 评分）和影像学结果（Maestro 标准）对患者进行评估。
67 名患者再次就诊，平均随访时间为 14.8 个月（范围为 12-24 个月）。两组的术后 AOFAS 评分相当（分别为 86.5 和 85.3）。两组的关节活动度相当。末次随访时，两组的静态问题（肿胀、跖痛、过度角化和脱位）相当。第 1 组中有 4 名患者和第 2 组中有 5 名患者出现跖痛复发。术后 3 个月时，第 1 组的肿胀和跖痛明显大于第 2 组。影像学测量（M1P1 角、M1M2 角和 Maestro 标准）相当。第 1 组中各跖骨的跖骨头回缩相同。末次随访时，所有截骨部位均已愈合。
使用 DMMO 或 Weil 截骨术治疗静态跖痛的结果相当。然而，DMMO 的术后恢复时间更长，这主要是因为肿胀。经皮 DMMO 技术并未改善关节活动度。
III 级，比较性回顾性研究。
