跗跖骨 1 融合中使用中足底板系统的适应证和可能的局限性 - 尸体研究。
Indications and possible limitations using medio-plantar plate systems in tarsometatarsal 1 fusions - A cadaveric study.
机构信息
Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany.
Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; Gelenkzentrum Rhein-Main, Fuß- Und Sprunggelenkschirurgie, Frankfurter Straße 94, 65239 Hochheim, Germany.
出版信息
Ann Anat. 2023 Oct;250:152145. doi: 10.1016/j.aanat.2023.152145. Epub 2023 Aug 18.
BACKGROUND
The tarsometatarsal 1 arthrodesis is an adequate treatment for moderate to severe hallux valgus deformity and instability of the first ray. Plantar plating arthrodesis has been shown to provide better mechanical stability and fewer postoperative complications than screw fixation or medial plating. The medio-plantar plate is a new plate design for Lapidus arthrodesis. It could combine the biomechanical advantages of the plantar plate and the anatomical overview of a medial plate. However, the implanted material can cause irritation of the tibialis anterior, which in some cases may require removal of the material. The purpose of this study was to examine the possibility of tendon irritation following medio-plantar first tarsometatarsal joint arthrodesis using cadaveric specimens.
METHODS
The study involved the simulated surgical procedure of medio-plantar plate arthrodesis on 30 lower extremities. After the plates were fixed, a thorough examination of the feet was conducted to assess any tendon irritation and to determine a recommendation for placement of the medio-plantar plate based on the Olewnik classification.
RESULTS
Irritation of the tibialis anterior tendon components with the medio-plantar plate depends mainly on the anatomic norm variant, classified according to Olewnik et al. A medio-plantar plate is particularly recommended in TA tendon Olewnik type 3 and type 5. The positioning of a medio-plantar plate in Olewnik type 1 and type 2 tendons depends on the anatomic fit of the medio-plantar plate and the bony configuration of the TMT 1 joint. A large portion of the TA tendon must be detached, so a different plate design may be preferred in these patients.
CONCLUSIONS
TMT 1 arthrodesis with medio-plantar plating of the first tarsometatarsal joint should be performed considering the anatomic TA tendon variations.
LEVEL OF EVIDENCE
Level V, Expert Opinion includes Case Reports and Technique Tips.
背景
跗跖关节 1 融合术是治疗中重度拇外翻畸形和第一跖骨不稳定的有效方法。与螺钉固定或内侧板固定相比，足底板融合术具有更好的机械稳定性和更少的术后并发症。中足底板是一种用于 Lapidus 融合术的新型板设计。它可以结合足底板的生物力学优势和内侧板的解剖学优势。然而，植入物可能会引起胫骨前肌的刺激，在某些情况下可能需要取出植入物。本研究旨在通过尸体标本检查中足底第一跗跖关节融合术后肌腱刺激的可能性。
方法
本研究模拟了 30 条下肢的中足底板融合术。在固定钢板后，对足部进行了全面检查，以评估任何肌腱刺激，并根据 Olewnik 分类确定中足底板的放置建议。
结果
胫骨前肌肌腱成分与中足底板的刺激主要取决于根据 Olewnik 等分类的解剖学正常变异。中足底板特别推荐用于 TA 肌腱 Olewnik 3 型和 5 型。Olewnik 1 型和 2 型肌腱中的中足底板定位取决于中足底板的解剖适配性和 TMT 1 关节的骨结构。大部分 TA 肌腱必须分离，因此这些患者可能更喜欢不同的板设计。
结论
在进行第一跗跖关节中足底板融合术时，应考虑到 TA 肌腱的解剖变异。
证据水平
V 级，专家意见包括病例报告和技术提示。
Zotero 插件