Institut de la Main, Clinique Bizet.
Necker Hospital Malades, Paris, France.
J Pediatr Orthop. 2021 Jan;41(1):56-60. doi: 10.1097/BPO.0000000000001662.
Apert syndrome is a rare condition characterized by a craniosynostosis associated with complex bilateral malformations of the hands and feet. Although correction of syndactyly of the extremities is largely described, just a few authors have focused their attention on the gradual subluxation of the second metatarsal head during child growth, with hyper pressure, hyperkeratosis on the plantar surface and acute pain leading to walking impairment. The aim of this study is to describe our experience with the Helal metatarsal osteotomy technique on this group of patients. An oblique osteotomy performed dorsal to plantar, proximal to distal on the subluxed metatarsal bone is carried out. No internal bone fixation is needed, but a fundamental hypercorrective bandage is placed under the plantar surface. Immediate full weight-bearing, 24 hours after surgery, is highly recommended.
Seventeen feet of 12 patients were treated between 2003 and 2018. Corrective osteotomy was performed on a single bone in 13 patients, on 2 bones in 3 patients, and on 3 bones on 1 patient. The mean follow-up was 5 years, with a physical examination once a year.
No complication such as infection or delayed wound healing was registered. X-rays taken 3 weeks after surgery showed complete bone consolidation and a correction of the previous plantarflexed position of the metatarsal with consistent reduction of pressure and pain for every patient who was able to wear normal shoes again after surgery.
The Helal metatarsal osteotomy is a safe, reproducible, and feasible technique that should be considered in cases of painful metatarsal head plantar subluxation in Apert feet.
Level IV.
Apert 综合征是一种罕见的疾病，其特征是颅缝早闭，伴有双侧手和脚的复杂畸形。尽管四肢并指畸形的矫正已被广泛描述，但只有少数作者关注过儿童生长过程中第二跖骨头的逐渐半脱位，伴有跖骨表面的高压、过度角化和剧烈疼痛，导致行走障碍。本研究旨在描述我们在这组患者中使用 Helal 跖骨切开术的经验。在跖骨背侧、近侧到远侧进行斜形切开，以矫正半脱位的跖骨。不需要内部骨固定，但需要在跖骨表面放置基本的过度矫正绷带。强烈建议术后 24 小时立即完全负重。
2003 年至 2018 年期间，共治疗了 12 名患者的 17 只脚。13 名患者进行了单一骨的矫正性切开术，3 名患者进行了 2 块骨的切开术，1 名患者进行了 3 块骨的切开术。平均随访 5 年，每年进行一次体格检查。
未发生感染或伤口愈合延迟等并发症。术后 3 周拍摄的 X 光片显示，所有患者的骨完全愈合，跖骨的先前跖屈位置得到矫正，压力和疼痛明显减轻，每位患者都能够在术后再次穿正常的鞋子。
Helal 跖骨切开术是一种安全、可重复和可行的技术，对于 Apert 足中跖骨头疼痛性跖侧半脱位的患者应考虑采用该技术。
IV 级。
