Coriaty Natalie, Pettibone Katherine, Todd Nicholas, Rush Shannon, Carter Ryan, Zdenek Colin
Fourth-year Student, California School of Podiatric Medicine, Oakland, CA.
Attending Physician, Chief of Surgical Services, Camino Division, Palo Alto Medical Foundation, Mountain View, CA.
J Foot Ankle Surg. 2018 May-Jun;57(3):593-599. doi: 10.1053/j.jfas.2017.10.011. Epub 2018 Jan 11.
Shortening of the first ray is a potential complication associated with first metatarsal procedures. Correction of this deformity conventionally has required the use of a tricortical bone graft to lengthen the bone. Graft complications, including donor site morbidity, poor graft stability, and graft resorption, have revealed a need for an alternative procedure. The present report shows that titanium cage scaffolding has lower extremity applications beyond its previous uses in the ankle and spine. Two patients underwent surgical correction for failed first ray procedures using a titanium cage apparatus with a calcaneal autograft and other biologic agents. The scaffolds were appropriately sized to fill the defect. Patients remained non-weightbearing until radiographic evidence of healing appeared. Success was determined by diminished pain, a return to activity, ambulation, and patient satisfaction. Patients exhibited faster-than-anticipated healing, including a return to protected weightbearing activities and increased stability within 6 weeks. Titanium cage implants provide long-term stability and resistance to stress and strain in the forefoot. The implant we have described, newly applied to the first ray, is analogous to a system used in salvage of failed ankle replacements. In addition to reducing reliance on the iliac crest bone graft, the titanium cage apparatus is advantageous because it is customized to fill a defect using computed tomography scanning, thereby reducing graft failure secondary to an improper shape. These cases demonstrate the potential beneficial applications for titanium cages in failed first ray reconstruction.
第一跖骨短缩是与第一跖骨手术相关的一种潜在并发症。传统上，矫正这种畸形需要使用三皮质骨移植来延长骨骼。包括供区并发症、植骨稳定性差和植骨吸收在内的移植并发症表明需要一种替代手术方法。本报告表明，钛笼支架在下肢的应用超出了其先前在踝关节和脊柱中的应用。两名患者因初次第一跖骨手术失败，使用带有自体跟骨移植和其他生物制剂的钛笼装置进行了手术矫正。支架尺寸合适，以填充缺损。在影像学显示愈合迹象之前，患者一直不负重。成功的判定标准为疼痛减轻、恢复活动能力、行走能力以及患者满意度。患者愈合速度比预期快，包括在6周内恢复到可保护性负重活动且稳定性增强。钛笼植入物在前足提供长期稳定性以及抗应力和应变能力。我们所描述的这种新应用于第一跖骨的植入物类似于用于挽救失败的踝关节置换术的系统。除了减少对髂嵴骨移植的依赖外，钛笼装置的优势在于它可通过计算机断层扫描定制以填充缺损，从而减少因形状不当导致的移植失败。这些病例证明了钛笼在失败的第一跖骨重建中的潜在有益应用。
