Krenn Sabine, Albers Sascha, Bock Peter, Mansfield Clemens, Chraim Michel, Trnka Hans-Joerg
Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).
Fußzentrum Vienna, Vienna, Austria (SA, HJT).
Foot Ankle Spec. 2018 Jun;11(3):263-268. doi: 10.1177/1938640017750251. Epub 2018 Jan 3.
Minimally invasive surgery has a shorter surgical time, and in this study we focus on minimally invasive distal metatarsal metaphyseal osteotomy (DMMO). The operation seems to be less complex but requires a high learning curve. We report on our first patients to underline the need for extensive training and great awareness for the risks in the early learning stages.
We evaluated 27 patients (mean age = 60.9 years) with a mean follow-up time of 7.2 months. Indication was metatarsalgia, intractable plantar keratosis, and the (sub-)luxation of the metatarsophalangeal joint. Clinical results were evaluated with the 12-item Short Form (SF-12), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM), and the American Orthopaedic Foot and Ankle Score (AOFAS). Radiographs and pedobarographic analysis were obtained.
Scores ranged closely to standard value (AOFAS 88.07 points; FFI 93%; FAAM 36.4 points; SF-12 31.27 points). Pedobarography showed significant differences in several forefoot areas. We encountered nonunion/malunion and necrosis of the metatarsal head.
The aim of this study was to demonstrate the need for intensive training before practicing DMMO. Results show that minimally invasive DMMO requires a high learning curve. Correct handling of the burr is associated with a lot of training. Wrong handling can lead to nonunion/malunion or necrosis.
Therapeutic, Level IV: Case series.
微创手术的手术时间较短，在本研究中，我们重点关注微创跖骨远端干骺端截骨术（DMMO）。该手术看似不太复杂，但需要较高的学习曲线。我们报告首例患者情况，以强调在早期学习阶段进行广泛培训以及高度重视风险的必要性。
我们评估了27例患者（平均年龄 = 60.9岁），平均随访时间为7.2个月。手术适应症为跖痛症、顽固性足底角化病以及跖趾关节（半）脱位。采用12项简短健康调查问卷（SF - 12）、足部功能指数（FFI）、足踝能力测量量表（FAAM）以及美国矫形足踝协会评分（AOFAS）对临床结果进行评估。同时获取了X线片和足底压力分析结果。
各项评分与标准值接近（AOFAS 88.07分；FFI 93%；FAAM 36.4分；SF - 12 31.27分）。足底压力分析显示前足多个区域存在显著差异。我们遇到了骨不连/骨畸形愈合以及跖骨头坏死的情况。
本研究的目的是证明在实施DMMO之前进行强化培训的必要性。结果表明，微创DMMO需要较高的学习曲线。正确操作磨钻需要大量训练。操作不当可能导致骨不连/骨畸形愈合或坏死。
治疗性，IV级：病例系列。
