Wu K K
Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan 48202.
J Foot Surg. 1987 Jul-Aug;26(4):277-92.
An analysis of 430 personal cases of Mitchell bunionectomy (517 feet) shows that there were 28 (6.5%) male patients and 402 (93.5%) female patients whose age ranged from 14 to 91 years with an average age of 48.5 years and follow-up periods ranging from 6 months to 14 years and 4 months. One hundred thirty-two (30.7%) second hammer toe operations accompanied these Mitchell bunionectomies, and all 430 patients had their second metatarsals longer than their corresponding first metatarsals by an average of 9.3 mm. The author employed a biplane plantar angulation and closing wedge valgus osteotomy of the first metatarsal neck that reduced the first metatarsophalangeal angle from an average of 30 to 13.8 degrees, and the first intermetatarsal angle from an average of 14.7 to 6.1 degrees, with an average first metatarsal shortening of 4.9 mm. The average lateral displacement of the first metatarsal head was 6.5 mm., and three cases of medial angulation and 13 cases of dorsal displacement of the first metatarsal head were encountered. By personally examining 100 randomly selected post-Mitchell bunionectomy patients, the author found that 85% of them had good to excellent results, and 15% had fair to poor results. Avascular necrosis, nonunion, or osteomyelitis of the first metatarsal was not found in this series. A reasonably short first metatarsal and senior citizens with adequate pedal circulation and healthy first metatarsophalangeal joints were fairly good candidates for Mitchell bunionectomy, and early, full weight bearing in a postbunionectomy toe spica walking cast appeared to be quite desirable. However, painful arthrosis of the first metatarsophalangeal joint, a very short first metatarsal, a very wide first intermetatarsal angle, and dysvascular and diabetic feet are poor candidates for Mitchell bunionectomy.
对430例米切尔拇囊炎切除术的个人病例（517只脚）进行分析发现，有28例（6.5%）男性患者和402例（93.5%）女性患者，年龄在14岁至91岁之间，平均年龄为48.5岁，随访期从6个月至14年零4个月。在这些米切尔拇囊炎切除术中，有132例（30.7%）同时进行了第二跖骨头锤状趾手术，所有430例患者的第二跖骨均比相应的第一跖骨长，平均长9.3毫米。作者采用了双平面足底成角和第一跖骨颈闭合楔形外翻截骨术，将第一跖趾关节角从平均30度降至13.8度，第一跖骨间角从平均14.7度降至6.1度，第一跖骨平均缩短4.9毫米。第一跖骨头的平均外侧移位为6.5毫米，遇到3例第一跖骨头内翻和13例第一跖骨头背侧移位。通过亲自检查100例随机选择的米切尔拇囊炎切除术后患者，作者发现其中85%的患者效果良好至极佳，15%的患者效果一般至较差。该系列中未发现第一跖骨的缺血性坏死、骨不连或骨髓炎。第一跖骨较短且足部血液循环良好、第一跖趾关节健康的老年人是米切尔拇囊炎切除术的相当合适的候选者，拇囊炎切除术后使用趾托步行石膏尽早完全负重似乎是非常可取的。然而，第一跖趾关节疼痛性关节炎、第一跖骨非常短、第一跖骨间角非常宽以及血管功能不良和糖尿病足是米切尔拇囊炎切除术的较差候选者。
