Magnan Bruno, Bonetti Ingrid, Negri Stefano, Maluta Tommaso, Dall'Oca Carlo, Samaila Elena
Orthopaedic Department, University of Verona School of Medicine, Italy.
Foot Ankle Surg. 2018 Oct;24(5):400-405. doi: 10.1016/j.fas.2017.04.012. Epub 2017 Apr 27.
Clinical and radiological results of percutaneous distal metatarsal minimally invasive osteotomy (DMMO) of the lesser rays for surgical treatment of primary metatarsalgia due to plantar overpressure with metatarsophalangeal instability are described. The aim of this prospective study was to assess the efficacy, feasibility and safety of this minimally invasive surgical (MIS) technique, verifying the possibility to lower the complication rate related to surgical exposures, to reduce operating times with comparable functional and cosmetic results to those reported with traditional open procedures.
Hundred and six consecutive percutaneous distal osteotomies without fixation (DMMO) of the second, third or fourth metatarsal bones were performed in 57 patients (70ft) with a mean age at the surgery of 60.2 years (30-81) for treatment of metatarsalgia with metatarsophalangeal instability. Patients were clinically assessed with the AOFAS and Coughlin's Scores, the latter classifying the results in relation to the patient's subjective satisfaction.
The mean follow-up was of 45.0±13.3months (24-68). All patients reported the disappearance or reduction of the pain that they had experienced prior to the operation around the metatarsal heads. The mean overall AOFAS score improved from 42.7±13.4 points (9-77) to 92.8±8.6 points (44-100) at the time of final follow-up. Patient subjective satisfaction according to Coughlin's classification was excellent in 62ft (88.6%), good in 7ft (10.0%), fair in 0ft and poor in one foot (1.4%).
We consider the percutaneous distal lesser metatarsal osteotomy without fixation (DMMO) a reliable surgical option in metatarsalgia due to metatarsophalangeal instability in early stages as in grade I and II according to Coughlin classification.
描述了经皮微创跖骨远端截骨术（DMMO）治疗因跖趾关节不稳定导致足底压力过大引起的原发性跖痛症的临床和影像学结果。这项前瞻性研究的目的是评估这种微创手术（MIS）技术的有效性、可行性和安全性，验证降低与手术暴露相关的并发症发生率的可能性，以及在功能和美容效果与传统开放手术相当的情况下减少手术时间。
对57例患者（70足）的第二、三或四跖骨进行了连续106例无固定的经皮远端截骨术（DMMO），患者平均手术年龄为60.2岁（30 - 81岁），用于治疗伴有跖趾关节不稳定的跖痛症。采用美国足踝外科协会（AOFAS）评分和考夫林评分对患者进行临床评估，考夫林评分根据患者主观满意度对结果进行分类。
平均随访时间为45.0±13.3个月（24 - 68个月）。所有患者均报告术前跖骨头周围疼痛消失或减轻。末次随访时，AOFAS总分平均从42.7±13.4分（9 - 77分）提高到92.8±8.6分（44 - 100分）。根据考夫林分类，患者主观满意度为优的占62足（88.6%），良的占7足（10.0%），中为0足，差的占1足（1.4%）。
我们认为，对于考夫林分类中I级和II级早期因跖趾关节不稳定导致的跖痛症，经皮微创无固定跖骨远端截骨术（DMMO）是一种可靠的手术选择。
