Tamir Eran, Finestone Aharon S, Avisar Erez, Agar Gabriel
Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Maccabi Health Services, POB 1424, Reut, 71799, Israel.
J Orthop Surg Res. 2016 Jul 11;11(1):78. doi: 10.1186/s13018-016-0414-x.
Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy.
Computerized medical files of patients with diabetic neuropathy treated with an osteotomy during 2013 and 2014 were retrospectively reviewed. There were 20 osteotomies performed on 17 patients (mean age 58 years). The patients had a diagnosis of DM for a mean of 17 years. All ulcers were University of Texas grade 1A; mean ulcer age was 19 months.
After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months. One patient developed an early post-operative infection with osteomyelitis at the osteotomy site (proximal shaft of the fifth metatarsal) that needed debridement and IV antibiotics. In the other 19 cases, the surgical wound healed within 1 week. Asymptomatic radiological non-union developed in six cases (30 %).
Mini-invasive floating metatarsal osteotomy can cure resistant and recurrent University of Texas grade 1A ulcerations plantar to the metatarsal heads in neuropathic patients.
患有周围神经病变且在跖骨头相对跖屈部位存在压力的患者，经常会出现足底溃疡。当使用矫形器和鞋子进行保守治疗无法治愈溃疡时，可能需要进行手术跖骨截骨术以减轻压力并促使溃疡愈合。本研究的目的是评估微创浮动跖骨截骨术在治疗糖尿病（DM）相关神经病变患者中跖骨头下方顽固性溃疡或复发性溃疡的应用。
回顾性分析2013年至2014年期间接受截骨术治疗的糖尿病神经病变患者的电子病历。对17例患者（平均年龄58岁）进行了20次截骨术。患者平均患有DM 17年。所有溃疡均为德克萨斯大学1A级；溃疡平均病程为19个月。
20例手术中有17例，溃疡在6周后完全愈合，平均随访11.5个月后未复发。1例患者在截骨部位（第五跖骨近端骨干）发生术后早期感染并伴有骨髓炎，需要进行清创和静脉注射抗生素治疗。在其他19例中，手术伤口在1周内愈合。6例（30%）出现无症状的影像学骨不连。
微创浮动跖骨截骨术可治愈神经病变患者中跖骨头下方难治性和复发性的德克萨斯大学1A级溃疡。
