Calis Mert, Oznur Ali, Ekin Omer, Vargel Ibrahim
*Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine †Ankara Güven Hospital, Orthopedics and Traumatology Clinic, Ankara, Turkey.
J Pediatr Orthop. 2016 Sep;36(6):582-8. doi: 10.1097/BPO.0000000000000503.
Apert foot anomalies may cause severe problems such as pain and development of callus formation related to weight redistribution, problems with footwear, and gait disturbances that may limit their daily activities. The main purpose of this study was to review our experience with distraction osteogenesis for the correction of brachymetatarsia and the great toe angulation of the patients with Apert syndrome.
This study retrospectively reviewed 7 patients (14 extremities) followed up for Apert syndrome who underwent distraction for the correction of bilateral congenital brachymetatarsia and angulation of the great toe between 2004 and 2008. Correction of the metatarsal inclination angle, the medial angulation of the great toe, the percentage of lengthening, and lengthening rates of distracted bones were evaluated.
Patients ranged in age from 4 to 8 years at the distraction operation, with a mean age of 5.4±1.3 years, and the average length of follow-up was 86.6±21.0 months. The length of the first metatarsal bone increased significantly from the average length of 32.6±5.7 mm to an average of 46.7±6.5 mm (P<0.001). The mean lengthening rate and lengthening percentages of distracted bones were 0.4%±0.1%/month and 30.2%±6.4%/month, respectively. Preoperative and postoperative metatarsal inclination angles were at a mean of 43.8±5.12 and 32.6±3.8, respectively, and the correction of metatarsal inclination was considered as statistically significant (P<0.001). The mean angulation of the great toe reduced significantly from 49.8±11.76 to 13.2±8.5 degrees after distraction (P<0.001). Minor complications such as pin loosening, pin-tract infection, and early union that required reoperation were observed in 5 extremities (35.7%).
Anatomic features of Apert foot may lead to complaints that may limit patients' daily activities and require as much attention as associated hand and craniofacial anomalies. Distraction appears to be an effective and safe approach for the simultaneous correction of the shortness of the first ray and medial angulation of the great toe.
Level IV.
Apert足畸形可能导致严重问题，如与体重重新分布相关的疼痛和胼胝形成、鞋类适配问题以及可能限制日常活动的步态障碍。本研究的主要目的是回顾我们运用牵张成骨术矫正Apert综合征患者跖骨短缩和拇趾内翻畸形的经验。
本研究回顾性分析了2004年至2008年间接受双侧先天性跖骨短缩和拇趾内翻畸形牵张矫正术的7例（14个肢体）Apert综合征患者的随访情况。评估了跖骨倾斜角、拇趾内翻角度、延长百分比以及牵张骨的延长率。
牵张手术时患者年龄为4至8岁，平均年龄为5.4±1.3岁，平均随访时间为86.6±21.0个月。第一跖骨长度从平均32.6±5.7毫米显著增加至平均46.7±6.5毫米（P<0.001）。牵张骨的平均延长率和延长百分比分别为0.4%±0.1%/月和30.2%±6.4%/月。术前和术后跖骨倾斜角分别平均为43.8±5.12和32.6±3.8，跖骨倾斜角的矫正具有统计学意义（P<0.001）。牵张后拇趾平均内翻角度从49.8±11.76度显著减小至13.2±8.5度（P<0.001）。5个肢体（35.7%）出现了如克氏针松动、针道感染和需要再次手术的早期骨愈合等轻微并发症。
Apert足的解剖特征可能导致一些会限制患者日常活动的问题，这些问题需要与相关的手部和颅面部畸形一样受到重视。牵张似乎是一种有效且安全的方法，可同时矫正第一跖骨短缩和拇趾内翻畸形。
四级。
