Matsuda Takenori, Taniguchi Akira, Hayashi Koji, Nakanishi Yasuaki, Tanaka Yasuhito
Orthopedist, Department of Orthopaedic Surgery, Otemae Hospital, Osaka, Japan.
Assistant Professor, Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.
J Foot Ankle Surg. 2018 Mar-Apr;57(2):414-417. doi: 10.1053/j.jfas.2017.08.025. Epub 2017 Dec 7.
Wide-awake surgery has potential advantages for treating extensor or flexor tendon injury. We present a case of chronic extensor hallucis longus injury treated with turn-down reconstruction using wide-awake surgery with a selective nerve block. To the best of our knowledge, this is the first such case reported. The patient had dropped a knife proximal to the right hallux metatarsophalangeal joint. Because direct suturing was thought to be difficult, turn-down reconstruction was performed under a selective nerve block. At 8 months postoperatively, the hallux had 75° of extension in the metatarsophalangeal joint and -5° of extension in the interphalangeal joint, similar to those of the healthy foot. The Japanese Society for Surgery of the foot objective hallux scale score had improved from 87 to 100, and the subjective scores in the subcategories of pain and pain-related, physical functioning and daily living, and shoe-related in the self-administered foot evaluation questionnaire had improved from 82.8 to 94.4, 97.7 to 100, and 50 to 83.3, respectively. Turn-down reconstruction using wide-awake surgery with a selective nerve block can be used for chronic extensor hallucis longus rupture and can be expected to provide good results.
清醒状态下手术在治疗伸肌腱或屈肌腱损伤方面具有潜在优势。我们报告一例慢性拇长伸肌损伤病例，采用清醒状态下手术结合选择性神经阻滞进行翻转重建治疗。据我们所知，这是首例此类报道病例。患者右拇趾跖趾关节近端不慎掉落一把刀。由于认为直接缝合困难，遂在选择性神经阻滞下进行翻转重建。术后8个月，拇趾跖趾关节伸展度为75°，趾间关节伸展度为 -5°，与健侧足部相似。日本足外科学会拇趾客观评分从87分提高到100分，在自我管理足部评估问卷中，疼痛及与疼痛相关、身体功能和日常生活、与鞋子相关等子类别中的主观评分分别从82.8分提高到94.4分、从97.7分提高到100分、从50分提高到83.3分。采用清醒状态下手术结合选择性神经阻滞进行翻转重建可用于慢性拇长伸肌断裂，有望取得良好效果。
