Yang Tzu-Cheng, Tzeng Yun-Hsuan, Wang Chien-Shun, Chang Ming-Chau, Chiang Chao-Ching
Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei,Taiwan.
Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei,Taiwan.
Foot Ankle Int. 2021 Feb;42(2):183-191. doi: 10.1177/1071100720961086. Epub 2020 Nov 2.
This retrospective study aimed to describe the techniques and results of distal metatarsal segmental shortening (DMSS) for the treatment of chronic irreducible metatarsophalangeal (MTP) dislocation of lesser toes.
We retrospectively reviewed patients who underwent DMSS for chronic dislocation of MTP joints of lesser toes between January 2010 and December 2017 with follow-up of at least 24 months. Demographic data, radiographic measurements, functional outcomes, and complications were analyzed. Furthermore, the results of patients with short segment of shortening (group I, <10 mm) were compared to those with long segment of shortening (group II, ≥10 mm). A total of 43 MTP joints of 30 patients with an average age of 70.4 years were included.
Union was observed in 42 metatarsals (97.7%). Mean American Orthopaedic Foot & Ankle Society scale scores improved significantly from 42.2 (range, 15-65) preoperatively to 79.1 (range, 52-90) ( < .001). Mean visual analog scale pain score improved significantly from 5.0 (range, 1-9) preoperatively to 1.8 (range, 0-6) ( < .001). Complications included 1 nonunion, 1 osteonecrosis, 3 metatarsal angulation, 4 recurrent instability, 4 symptomatic osteoarthritis, 3 transfer metatarsalgia, and 1 floating toe. Group I included 23 MTP joints and group II included 20 MTP joints. There was no significant difference in clinical outcomes and complications between the 2 groups.
DMSS was a reliable procedure for the treatment of chronic irreducible dislocated MTP joint of lesser toes. It provided satisfactory surgical outcomes and a low rate of postoperative complications, regardless of length of metatarsal shortening.
Level III, retrospective comparative study.
本回顾性研究旨在描述远端跖骨节段性缩短术（DMSS）治疗小趾慢性不可复位跖趾（MTP）关节脱位的技术及结果。
我们回顾性分析了2010年1月至2017年12月期间接受DMSS治疗小趾MTP关节慢性脱位且随访至少24个月的患者。分析了人口统计学数据、影像学测量结果、功能结局及并发症。此外，比较了短节段缩短组（I组，<10 mm）与长节段缩短组（II组，≥10 mm）患者的结果。共纳入30例患者的43个MTP关节，平均年龄70.4岁。
42例跖骨（97.7%）实现愈合。美国矫形足踝协会平均评分从术前的42.2（范围15 - 65）显著提高至79.1（范围52 - 90）（P <.001）。视觉模拟量表平均疼痛评分从术前的5.0（范围1 - 9）显著改善至1.8（范围0 - 6）（P <.001）。并发症包括1例骨不连、1例骨坏死、3例跖骨成角、4例复发性不稳定、4例症状性骨关节炎、3例转移性跖痛症及1例漂浮趾。I组包括23个MTP关节，II组包括20个MTP关节。两组间临床结局及并发症无显著差异。
DMSS是治疗小趾慢性不可复位脱位MTP关节的可靠术式。无论跖骨缩短长度如何，均能提供满意的手术效果及较低的术后并发症发生率。
III级，回顾性比较研究。
