Cracchiolo A, Kitaoka H B, Leventen E O
University of California, UCLA Medical Center 90024.
Foot Ankle. 1988 Aug;9(1):10-8. doi: 10.1177/107110078800900104.
Subluxation or dislocation of the second metatarsophalangeal joint (MTPJ) is usually associated with a hammertoe deformity and, frequently, with a significant hallux valgus deformity. Although the joint itself may be painful, there is also pain in the hammertoe deformity, especially when the patient is wearing closed shoes. A painful intractable plantar keratosis is usually present. We reviewed all of our patients with second MTPJ subluxation or dislocation, in whom a double-stem silicone implant had been used to relocate the joint. In 31 feet of 28 patients, 32 implants were used. All but six feet with advanced degenerative joint disease secondary to Freiberg's infraction had severe associated forefoot pathology that necessitated surgical correction. Several feet had previous bunion operations as well as operations on the second toe. In addition to the second toe, we performed hallux valgus corrections in 23 feet, seven of which were revision procedures. At an average follow-up time of 37 months, good results were seen in 20 feet (63%), good results with reservations in eight feet (25%), and failure in four feet (12%). Transfer metatarsalgia was the most frequent complication. The implants remained stable, and in only one was there a suspected fracture. More optimum results might have been achieved had there been better correction of the hallux valgus deformities, more frequent correction of the hammertoe deformity, and less resection of the second metatarsal head. These patients with pathology usually involving both the first and second MTPJ are difficult to treat, therefore. Their results are less predictable and not as favorable as those achieved for patients with isolated similar deformities.
第二跖趾关节（MTPJ）半脱位或脱位通常与锤状趾畸形相关，且常常伴有明显的拇外翻畸形。尽管关节本身可能疼痛，但锤状趾畸形部位也会疼痛，尤其是患者穿封闭性鞋子时。通常会出现疼痛性顽固性足底角化病。我们回顾了所有使用双柄硅胶植入物来复位关节的第二MTPJ半脱位或脱位患者。28例患者的31只足使用了32枚植入物。除6只因弗赖伯格骨折继发严重退行性关节病的足外，其余所有足均伴有严重的前足病变，需要手术矫正。几只足之前接受过拇囊炎手术以及第二趾手术。除第二趾手术外，我们还对23只足进行了拇外翻矫正，其中7只是翻修手术。平均随访37个月时，20只足（63%）效果良好，8只足（25%）效果尚可但有保留意见，4只足（12%）治疗失败。转移性跖痛症是最常见的并发症。植入物保持稳定，仅1例疑似有骨折。如果能更好地矫正拇外翻畸形、更频繁地矫正锤状趾畸形以及减少第二跖骨头的切除，可能会取得更理想的效果。因此，这些通常累及第一和第二MTPJ的病变患者很难治疗。他们的治疗结果较难预测，且不如孤立性类似畸形患者的治疗结果理想。
