Brown Michael J C, Yeoman Thomas F M, Roberts Sam, Pillai Anand
Ninewells Hospital, Dundee, UK.
Foot Ankle Spec. 2012 Dec;5(6):389-93. doi: 10.1177/1938640012463059. Epub 2012 Oct 16.
Brachymetatarsia is an abnormal shortening of a metatarsal. It causes disruption of the normal metatarsal parabola, resulting in metatarsalgia, calluses and dislocation of the digits. Patients often express discontent with the appearance of their feet. Lengthening by distraction osteogenesis and 1-stage intercalary bone grafting procedures are the mainstays of operative treatment. We present a modified 1-stage technique, combining the use of a Chevron osteotomy of the fourth metatarsal with shortening osteotomies of the second and third metatarsals. Bone removed from the third metatarsal was used to lengthen the fourth. The Chevron segments provided mediolateral, dorsoplantar, and rotational stability. The technique was used on both feet of 1 patient. The mean increase in AOFAS score was 34.5 (right foot, 46; left foot, 23.) There were no complications. A 1-stage technique does not require an external fixator or postoperative manipulation and has a quicker healing time. Taking the bone graft from neighboring metatarsals decreases the discrepancy between metatarsal lengths. A smaller increase in the length of the fourth ray is then required, and the chance of neurovascular injury as a result of soft-tissue stretching is minimized. This technique allows restoration of the metatarsal parabola and provides good correction, immediate stability, and good integration.
Therapeutic Level IV, Case Study.
跖骨短小症是跖骨的异常缩短。它会破坏正常的跖骨抛物线，导致跖痛症、胼胝和趾骨脱位。患者常常对自己足部的外观不满意。牵张成骨延长术和一期节段性骨移植手术是手术治疗的主要方法。我们介绍一种改良的一期技术，即将第四跖骨的V形截骨术与第二和第三跖骨的缩短截骨术相结合。从第三跖骨取下的骨头用于延长第四跖骨。V形截骨段提供了内外侧、背跖侧和旋转稳定性。该技术应用于1例患者的双足。美国足踝外科协会（AOFAS）评分平均提高了34.5分（右脚提高46分，左脚提高23分）。无并发症发生。一期技术不需要外固定架或术后手法操作，愈合时间更快。从相邻跖骨获取骨移植材料可减少跖骨长度差异。这样第四跖骨射线长度只需较小增加，因软组织拉伸导致神经血管损伤的几率降至最低。该技术可恢复跖骨抛物线，提供良好的矫正效果、即时稳定性和良好的融合。
治疗性四级，病例研究。
