Fusini Federico, Langella Francesco, Catani Ottorino, Sergio Fabrizio, Zanchini Fabio
Resident Orthopaedic Surgeon, Clinical Orthopaedics, Second University of Naples, Naples, Italy.
Orthopaedic Surgeon, Clinical Orthopaedics, Second University of Naples, Naples, Italy.
J Foot Ankle Surg. 2017 Mar-Apr;56(2):390-394. doi: 10.1053/j.jfas.2016.10.015. Epub 2017 Jan 6.
Brachymetatarsia is a rare disease defined by metatarsal shortening and characterized by aesthetic dissatisfaction with or without pain. The aim of our study was to evaluate the outcomes of fourth ray brachymetatarsia treated with percutaneous osteotomy using a mini-burr and gradual lengthening with external fixation. A total of 7 females were recruited for the study; 6 (85.71%) of whom had a bilateral deformity, for a total of 13 feet affected by fourth ray brachymetatarsia. Percutaneous diaphysis osteotomy with a mini-burr followed by metatarsal elongation was performed. Metatarsal lengthening was measured as the difference between the preoperative and postoperative length at external fixator removal. The American Orthopaedic Foot and Ankle Society lesser toe metatarsophalangeal-interphalangeal score, patient satisfaction, restoration of Leliévre parabola, and treatment time were evaluated. Numerical data are reported as the mean ± standard deviation and 95% confidence intervals. The Mann-Whitney U test was used to compare the changes in the AOFAS score with a level of significance of p < .05. The mean metatarsal lengthening was 17.46 ± 4.89 (95% confidence interval [CI] 14.8 to 20.12) mm and the mean treatment time was 99.23 ± 8.53 (95% CI 94.59 to 103.87) days. The mean American Orthopaedic Foot and Ankle Society lesser toe metatarsophalangeal-interphalangeal score improved significantly from 76.38 ± 2.66 (95% CI 74.77 to 78.03) preoperatively to 86.46 ± 1.45 (95% CI 84.85 to 88.07) postoperatively (p < .01). In 12 of 13 feet (92.31%), the Leliévre parabola was restored, and the patients were satisfied with the clinical outcomes. The results of our study demonstrate that percutaneous osteotomy with the mini-burr and external fixation is an effective treatment for lengthening of fourth ray brachymetatarsia. Furthermore, we found good clinical and functional outcomes, high patient satisfaction, and a similar duration of treatment compared with other gradual lengthening procedures.
短跖骨症是一种罕见疾病，其定义为跖骨缩短，特征为伴有或不伴有疼痛的美学缺陷。本研究的目的是评估使用微型磨钻经皮截骨术及外固定逐步延长治疗第四跖骨短缩症的疗效。本研究共纳入7名女性；其中6名（85.71%）为双侧畸形，共有13只足受第四跖骨短缩症影响。采用微型磨钻进行经皮骨干截骨术，随后进行跖骨延长。跖骨延长量通过拆除外固定器时术前和术后长度之差来测量。评估美国矫形足踝协会小趾跖趾关节-趾间关节评分、患者满意度、勒利埃弗抛物线恢复情况及治疗时间。数值数据以均数±标准差和95%置信区间表示。采用曼-惠特尼U检验比较美国矫形足踝协会（AOFAS）评分的变化，显著性水平为p < 0.05。平均跖骨延长量为17.46±4.89（95%置信区间[CI] 14.8至20.12）mm，平均治疗时间为99.23±8.53（95% CI 94.59至103.87）天。美国矫形足踝协会小趾跖趾关节-趾间关节评分均值从术前的76.38±2.66（95% CI 74.77至78.03）显著提高至术后的86.46±1.45（95% CI 84.85至88.07）（p < 0.01）。13只足中的12只（92.31%）恢复了勒利埃弗抛物线，患者对临床疗效满意。我们的研究结果表明，使用微型磨钻经皮截骨术及外固定是治疗第四跖骨短缩症延长的有效方法。此外，我们发现与其他逐步延长手术相比，该方法具有良好的临床和功能疗效、较高的患者满意度以及相似的治疗时长。
