Davies G F
New York College of Podiatric Medicine, New York.
Clin Podiatr Med Surg. 1989 Jan;6(1):93-102.
Plantarflexory base wedge osteotomy has proven to be a viable, rewarding treatment, where first metatarsal phalangeal joint pathology, as a result of metatarsus primus elevatus, is predicted or in its earliest forms. Although this topic was first addressed by Lambrinudi in 1938, it has received little notice in the literature, and its relevance is probably underestimated. In fact, the diagnosis of metatarsus primus elevatus with associated advancing degenerative joint disease is probably being missed in a significant number of patients. The early signs of this condition are often disregarded even by professionals and the patient frequently is told there is nothing wrong. Not until hallux limitus or hallux rigidus develops is concern demonstrated, at which point a joint preservation procedure is no longer viable. The recovery from plantarflexory base wedge osteotomy does require a longer time period before return to weight bearing as compared with more commonly performed foot surgeries. This must, however, be weighed against the consideration of a patient needing joint resection surgery at a later date, not infrequently in their late 30s or 40s. In fact, a significant patient population in the 35 to 45 age group exists, in whom one prefers to do neither an implant surgery nor a joint destructive surgery, but in whom the joint has been significantly damaged. Performing plantarflexory base wedge osteotomy in appropriately selected patients will re-establish normal function and preserve the first metatarsal phalangeal joint articular cartilage. This approach offers the benefit of arresting the joint destructive process and avoiding the need for a joint destructive procedure in a younger patient.
跖屈基底楔形截骨术已被证明是一种可行且有效的治疗方法，适用于因第一跖骨抬高而导致的第一跖趾关节病变处于预测阶段或早期形式的情况。尽管这个话题最早由兰布里努迪在1938年提出，但在文献中很少受到关注，其相关性可能被低估了。事实上，相当多的患者可能漏诊了伴有退行性关节病进展的第一跖骨抬高。即使是专业人员也常常忽视这种疾病的早期症状，患者通常被告知没有问题。直到出现拇趾僵硬或拇趾强直才引起关注，此时关节保留手术已不再可行。与更常见的足部手术相比，跖屈基底楔形截骨术后恢复负重所需的时间确实更长。然而，这必须与患者日后需要进行关节切除手术的情况相权衡，这种情况在他们三十多岁或四十多岁时并不少见。实际上，存在一个35至45岁的庞大患者群体，对于他们，既不倾向于进行植入手术也不倾向于进行关节破坏手术，但他们的关节已受到严重损害。在适当选择的患者中进行跖屈基底楔形截骨术将重建正常功能并保留第一跖趾关节的关节软骨。这种方法的好处是可以阻止关节破坏过程，并避免在年轻患者中进行关节破坏手术。
