跖板射频消融术和韦尔截骨术治疗轻度跖趾关节不稳
Plantar plate radiofrequency and Weil osteotomy for subtle metatarsophalangeal joint instablity.
作者信息
Nery Caio, Raduan Fernando C, Catena Fernanda, Mann Tania Szejnfeld, de Andrade Marco Antonio Percope, Baumfeld Daniel
机构信息
UNIFESP-Escola Paulista de Medicina, São Paulo, SP, Brazil.
UFMG-Federal University of Minas Gerais, Juvenal dos Santos St, 325, Belo Horizonte, MG, 30380 5030, Brazil.
出版信息
J Orthop Surg Res. 2015 Nov 19;10:180. doi: 10.1186/s13018-015-0318-1.
BACKGROUND
To the present day, literature has only discussed how to treat extensive plantar plate and collateral ligament lesions, with gross joint subluxation and obvious clinical instability. The treatment options for early stages of the disease with minor injuries and subtle instabilities have not been described. The main purpose of this prospective study is to evaluate the efficacy of the combination of the arthroscopic radiofrequency shrinkage and distal Weil osteotomy in the treatment of subtle metatarsophalangeal joint instability.
METHOD
Prospective data (clinical, radiological, and arthroscopic findings) of 19 patients, with a total of 35 slightly unstable joints, was collected. The physical examination defined the hypothesis for plantar plate lesions (grades 0 and 1), which was confirmed during the diagnostic step of the arthroscopic procedure.
RESULTS
Among our patients, 73% were females and 63% reported wearing high heels. The average age was 59 years and post-operative follow-up was 20 months. In the initial sample frame, 62% of joints showed spread-out toes with increased interdigital spacing. The mean American Orthopedic Foot and Ankle Society score rose from 53 points pre-operatively to 92 points post-operatively and a visual-analog pain scale average value of eight points pre-operatively decreased to zero post-operatively. During the pre-operative evaluation, none of the patients had stable joints and over 97% were classified as having grade 1 instability (<50% subluxation). After treatment, 83% of the joints became stable (degree of instability 0) and over 97% were congruent. All studied parameters showed statistically significant improvements in the post-operative period (p < 0.001) showing the efficiency of the treatment in pain relief, while restoring the joint stability and congruity.
CONCLUSION
Arthroscopic radiofrequency shrinkage in combination with distal Weil osteotomy promotes functional improvement, pain relief, and restores the joint stability in the plantar plate lesion grades 0 and 1.
背景
时至今日，文献仅讨论了如何治疗广泛的跖板和侧副韧带损伤，伴有明显的关节半脱位和明显的临床不稳定。对于疾病早期损伤轻微且不稳定不明显的治疗选择尚未有描述。这项前瞻性研究的主要目的是评估关节镜下射频收缩术与远端韦尔截骨术联合治疗轻微跖趾关节不稳定的疗效。
方法
收集了19例患者共35个轻微不稳定关节的前瞻性数据（临床、放射学和关节镜检查结果）。体格检查确定了跖板损伤的假设（0级和1级），这在关节镜手术的诊断步骤中得到了证实。
结果
在我们的患者中，73%为女性，63%报告穿高跟鞋。平均年龄为59岁，术后随访20个月。在初始样本中，62%的关节表现为脚趾散开，趾间间距增加。美国矫形足踝协会评分术前平均为53分，术后升至92分，视觉模拟疼痛量表平均值术前为8分，术后降至0分。术前评估时，所有患者的关节均不稳定，超过97%被归类为1级不稳定（半脱位<50%）。治疗后，83%的关节变得稳定（不稳定程度为0级），超过97%的关节恢复正常。所有研究参数在术后均有统计学显著改善（p<0.001），表明该治疗在缓解疼痛、恢复关节稳定性和正常方面有效。
结论
关节镜下射频收缩术与远端韦尔截骨术联合应用可促进功能改善、缓解疼痛，并恢复0级和1级跖板损伤的关节稳定性。
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