Gvildys P, Clark B, Prigoff M M
Department of Podiatric Surgery, Dallas Family Hospital, Texas.
J Foot Surg. 1989 Sep-Oct;28(5):454-8.
Children between 6 and 8 years of age with metatarsus adductus deformity have been considered to be in the gray zone for surgical correction. Should osseous or soft tissue procedures be implemented to reduce the adducted attitude of the metatarsals? The literature clearly describes one or the other and the intermediary chondrotomy procedure described by Johnson. The use of a combined approach has not been presented. The present authors offer a brief review of metatarsus adductus, and two case reports using a modified, combined approach. Two 7-year-old girls presented with bilateral resistant metatarsus adductus deformities. The authors contend that the first and fifth metatarsals are the major deforming forces in this age group, and may be corrected with base wedge osteotomies, while the central three metatarsals are more amendable to capsular and ligamentous releases. Advantages of soft tissue procedures on the central rays include avoidance of extensive dissection, creating less trauma and avoidance of the need for internal fixation. The obvious disadvantage is the inability to adequately reduce the deformity. This can be assessed intraoperatively. These authors, therefore, conclude that this modified surgical approach is a viable alternative to the previously described procedures for resistant metatarsus adductus.
6至8岁患有内收型足畸形的儿童一直被认为处于手术矫正的灰色地带。是应该采用骨性或软组织手术来减少跖骨的内收姿势呢？文献中明确描述了其中一种或另一种，以及约翰逊所描述的中间软骨切开术。尚未有关于联合方法使用的报道。本文作者简要回顾了内收型足畸形，并给出了两例采用改良联合方法的病例报告。两名7岁女孩患有双侧顽固性内收型足畸形。作者认为，第一和第五跖骨是该年龄组主要的致畸形力量，可通过基底楔形截骨术进行矫正，而中间三根跖骨更适合进行关节囊和韧带松解。对中间跖骨进行软组织手术的优点包括避免广泛解剖、减少创伤以及避免内固定的需要。明显的缺点是无法充分矫正畸形。这可以在术中评估。因此，这些作者得出结论，这种改良的手术方法是治疗顽固性内收型足畸形的一种可行替代方法，可替代先前描述的手术方法。
