Lamm Bradley M, Gourdine-Shaw Monique C, Thabet Ahmed M, Jindal Gaurav, Herzenberg John E, Burghardt Rolf D
Head of Foot and Ankle Surgery and Director, Foot and Ankle Deformity Correction Fellowship, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
Chief of Podiatry, Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD.
J Foot Ankle Surg. 2014 Sep-Oct;53(5):567-76. doi: 10.1053/j.jfas.2014.04.008. Epub 2014 Jun 2.
Open midfoot wedge osteotomy correction can cause neurovascular compromise, requires extensive exposure, sacrifices normal joints, and shortens the foot. We used a minimally invasive technique to treat complex foot deformities by combining percutaneous Gigli saw midfoot osteotomy, circular external fixation, and acute, gradual, or gradual with acute manipulation correction. The medical records of 23 patients (26 feet) with complex foot deformities (congenital, 18 feet; neuromuscular, 4 feet; post-traumatic, 3 feet; malunion, 1 foot) who had undergone treatment within an 18-year period (1990 through 2007) were retrospectively reviewed. We also performed the procedure on 10 cadaveric limbs to determine whether anatomic structures were at risk. Correction was achieved in all feet. The mean duration of external fixation treatment was 4.2 (range 3 to 7) months. The mean follow-up duration was 4.7 (range 2 to 18) years. A significant difference was observed in the pre- and postoperative, lateral view, talar-first metatarsal angle (p = .001). Minor complications (4 feet) consisted of bony exostoses. Major complications included recurrent deformity in 3 feet and sural nerve entrapment in 1 foot. Two patients had mild and one moderate foot pain. Three patients had impaired gait function; the remaining patients had functional gait. The mean interval until wearing regular shoes after external fixation removal was 2.3 (range 1 to 4) months. All but 1 of the patients were satisfied with the final results. We observed no cadaveric neurovascular injury. Our results have shown that percutaneous Gigli saw midfoot osteotomy can be performed without neurovascular injury and is capable of successfully correcting complex foot deformities.
开放性中足楔形截骨矫正术可导致神经血管受损，需要广泛暴露，牺牲正常关节，并使足部缩短。我们采用一种微创技术，通过联合经皮Gigli锯中足截骨术、环形外固定以及急性、渐进性或渐进性与急性相结合的手法矫正来治疗复杂的足部畸形。回顾性分析了1990年至2007年18年间接受治疗的23例（26足）复杂足部畸形患者（先天性，18足；神经肌肉性，4足；创伤后，3足；畸形愈合，1足）的病历。我们还在10具尸体肢体上进行了该手术，以确定解剖结构是否有风险。所有足部均实现了矫正。外固定治疗的平均持续时间为4.2（范围3至7）个月。平均随访时间为4.7（范围2至18）年。术前和术后侧位观距骨 - 第一跖骨角有显著差异（p = .001）。轻微并发症（4足）包括骨赘。主要并发症包括3足复发畸形和1足腓肠神经卡压。2例患者有轻度足部疼痛，1例中度足部疼痛。3例患者步态功能受损；其余患者步态功能正常。外固定拆除后直至能穿常规鞋子的平均间隔时间为2.3（范围1至4）个月除1例患者外，所有患者对最终结果满意。我们未观察到尸体神经血管损伤。我们的结果表明，经皮Gigli锯中足截骨术可在不损伤神经血管的情况下进行，并且能够成功矫正复杂的足部畸形。
