Woo Sang Hyun, Bang Chi Young, Ahn Hee-Chan, Kim Sung-Jung, Choi Jun-Young
Department of Plastic and Reconstructive Surgery, W Hospital, Daegu, Republic of Korea.
Department of Plastic and Reconstructive Surgery, W Hospital, Daegu, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2017 May;70(5):666-672. doi: 10.1016/j.bjps.2017.02.020. Epub 2017 Feb 28.
We present a one-stage procedure for lengthening the fourth brachymetatarsia with autogenous iliac bone and cartilage cap grafting for the anatomical reconstruction of the metatarsophalangeal (MTP) joint METHODS: During the last 8 years, 56 feet in 41 patients with congenital brachymetatarsia of the fourth toe were corrected with a one-stage operation to reposition the articular cartilage cap to the distal part of interpositional iliac bone graft at the metatarsal epiphysis.
The length of the harvested iliac bone graft was 22.9 mm on average. The mean fixation period was 58.5 days, and the mean gain in length and percentage increase was 20.9 mm and 39%, respectively. MRI showed a stable MTP joint over viable cartilage cap in 83.3% of the cases. Mean postoperative American Orthopedic Foot and Ankle Society lesser MTP-interphalangeal score was 82.0. Neither neurovascular impairment nor recurrence of brachymetatarsia occurred in the mean follow-up period of 43.6 months. All patients were satisfied with the postoperative cosmetic results. Thirteen patients (23.2%) complained of limited active dorsiflexion of the fourth toe, and extensor adhesion was released by extensor tenolysis in only one patient. In a single case of nonunion at the bone graft site, additional surgery was not necessary.
Anatomical reconstruction of the fourth brachymetatarsia with one-stage interpositional iliac bone and cartilage cap grafting resulted in excellent cosmetic results and a physiologic MTP joint, providing the benefits of one-stage lengthening with a low complication rate.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
我们介绍一种一期手术方法，通过自体髂骨和软骨帽移植来延长第四短缩跖骨，以实现跖趾关节（MTP）的解剖重建。方法：在过去8年中，对41例先天性第四趾短缩跖骨患者的56只足进行了一期手术矫正，将关节软骨帽重新定位到跖骨骨骺处的髂骨植入物远端。
所取髂骨植入物的平均长度为22.9毫米。平均固定期为58.5天，长度平均增加20.9毫米，增加百分比为39%。MRI显示，83.3%的病例中，MTP关节在存活的软骨帽上保持稳定。术后美国矫形足踝协会（American Orthopedic Foot and Ankle Society）小趾跖趾间关节平均评分为82.0。在平均43.6个月的随访期内，未发生神经血管损伤或短缩跖骨复发。所有患者对术后美容效果均满意。13例患者（23.2%）抱怨第四趾主动背屈受限，仅1例患者通过伸肌腱松解术松解了伸肌粘连。在1例骨移植部位骨不连的病例中，无需进行额外手术。
采用一期髂骨植入和软骨帽移植对第四短缩跖骨进行解剖重建，可获得优异的美容效果和生理性MTP关节，具有一期延长的优点且并发症发生率低。
临床问题/证据水平：治疗性，IV级。
