Herzog Jessica L, Goforth W David, Stone Paul A, Paden Matthew H
Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO.
Director of Research, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Colorado Health Foundation, Denver, CO.
J Foot Ankle Surg. 2014 Mar-Apr;53(2):131-6. doi: 10.1053/j.jfas.2013.12.018.
A long metatarsal and/or metatarsophalangeal joint dislocation associated with a digital contracture is a surgical challenge. Without appropriate surgical correction, the patient will be predisposed to numerous complications, including persistent subluxation or dislocation, recurrent metatarsalgia, dorsiflexory contracture of the digit, transfer lesions, and inadequate pain relief. The results of the present surgical treatment options have varied, with the most common complication being a floating toe. The purpose of our study was to introduce a decompression, shortening, lesser metatarsal osteotomy with a modified fixation technique using a T-plate and to report our results. Additionally, we have discussed trigonometric analysis of metatarsal declination and shortening. We retrospectively reviewed the outcomes of 30 consecutive patients with 33 osteotomies who had been treated surgically for pathologic features associated with a long metatarsal and varying biomechanical abnormalities. Before surgery, all the patients had been treated conservatively for a minimum of 3 months. The surgical procedure included a dorsal to plantar V-shaped shortening osteotomy of a lesser metatarsal that was fixated with a T plate. The patients were assessed radiographically and using the American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal Scale and visual analog scale. The mean age at surgery was 53 (range 37 to 75) years, with a mean follow-up period of 9.1 (range 6 to 15.4) months. The average shortening of the metatarsal was 2.7 mm. One patient (3%) had had asymptomatic delayed union and 2 patients (6%) hypertrophic nonunion. No incidence of malunion or avascular necrosis was identified. Five cases (15.2%) of hardware failure occurred. The mean American Orthopaedic Foot and Ankle Society score was 76.7 postoperatively. The visual analog scale score had improved from 6.7 to 1.7. Of the 30 patients, 72% rated the overall surgical experience as excellent or good. In conclusion, the modified fixation technique for decompression, shortening metatarsal osteotomy using a T plate is a viable option when choosing a procedure to address a long, prominent metatarsal and/or digital contracture at the metatarsophalangeal joint and results in a low incidence of floating toe complications.
伴有趾挛缩的长跖骨和/或跖趾关节脱位是一项手术挑战。若未进行适当的手术矫正，患者易出现多种并发症，包括持续性半脱位或脱位、复发性跖痛症、趾背屈挛缩、转移性病变以及疼痛缓解不足。目前手术治疗方案的结果各异，最常见的并发症是漂浮趾。我们研究的目的是介绍一种减压、缩短、使用T形钢板改良固定技术的小跖骨截骨术，并报告我们的结果。此外，我们还讨论了跖骨倾斜度和缩短的三角分析。我们回顾性分析了连续30例患者（共33处截骨术）的手术结果，这些患者因长跖骨相关的病理特征和不同的生物力学异常接受了手术治疗。术前，所有患者均接受了至少3个月的保守治疗。手术过程包括对小跖骨进行背侧到跖侧的V形缩短截骨术，并用T形钢板固定。对患者进行了影像学评估，并使用美国矫形足踝协会小跖趾-趾间关节评分量表和视觉模拟评分量表进行评估。手术时的平均年龄为53岁（范围37至75岁），平均随访期为9.1个月（范围6至15.4个月）。跖骨平均缩短2.7毫米。1例患者（3%）出现无症状延迟愈合，2例患者（6%）出现肥大性骨不连。未发现畸形愈合或缺血性坏死病例。发生了5例（15.2%）内固定失败。术后美国矫形足踝协会平均评分为76.7分。视觉模拟评分从6.7分改善至1.7分。30例患者中，72%对总体手术体验的评价为优秀或良好。总之，当选择手术治疗长而突出的跖骨和/或跖趾关节趾挛缩时，使用T形钢板进行减压、缩短跖骨截骨术的改良固定技术是一种可行的选择，且漂浮趾并发症的发生率较低。
