Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Orthop Surg. 2024 Sep;16(9):2148-2156. doi: 10.1111/os.14204. Epub 2024 Aug 26.
Surgical technique in distraction osteogenesis for the treatment of brachymetatarsia can influence the final prognosis. However, there are currently no standardized guidelines for surgical procedures and complication management. The aim of this study is to investigate the effect of bone lengthening with external fixation by minimally invasive osteotomy based on Ilizarov technique in the treatment of congenital brachymetatarsia.
A retrospective study was conducted on patients with congenital brachymetatarsia treated by metatarsal lengthening, from June 2017 to December 2020. There were 11 patients with 17 shorted fourth metatarsals, including 10 females and 1 male, with age of 24.6 ± 4.5 years (16-31 years). Six patients were bilaterally involved. Orthofix external fixator mini track was installed through dorsal approach and the fourth MTP joints were temporarily fixed by Kirschner wire. Bone lengthening was performed after a minimally invasive osteotomy at the proximal metatarsals. American Orthopedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal (MTP-IP) scores, metatarsal length, complications were recorded. Statistical comparison was performed using the paired t-student test for pre- and postoperative AOFAS MTP-IP scores.
Patients were followed up for 55 ± 10.8 months. The mean length of the fourth metatarsal bone was 49.9 ± 2.9 mm preoperatively. The mean metatarsal shortage was 18.8 ± 3.1 mm. The mean lengthening achieved was 19.8 ± 3.3 mm, with a lengthening ratio of 39.7% ± 6.6%. The lengthened callus ossified completely at 3-4 months after operation. All patients were satisfied with the results of lengthening. The AOFAS scores were improved significantly from 83.7 ± 4.2 preoperatively to 93.2 ± 2.7 postoperatively (t = -10.27, p < 0.001). One patient with traumatic metatarsophalangeal joint subluxation was treated by joint reduction and Kirschner wire fixation. One patient had metatarsophalangeal joint release and Kirschner wire fixation due to flexion contracture. Pin tract infections were controlled by wound care and antibiotics in 6 patients. All patients had no nonunion, necrosis of toes, and sensory disturbance of toes.
Metatarsal lengthening by minimally invasive osteotomy with external fixator had satisfactory results in the treatment of congenital brachymetatarsia.
在治疗短趾畸形的骨延长术中，手术技术可能会影响最终预后。然而，目前还没有关于手术程序和并发症管理的标准化指南。本研究旨在探讨基于伊利扎罗夫技术的微创截骨外固定骨延长术治疗先天性短趾畸形的效果。
对 2017 年 6 月至 2020 年 12 月采用跖骨延长术治疗的先天性短趾畸形患者进行回顾性研究。共有 11 例 17 例第四跖骨缩短患者，其中女性 10 例，男性 1 例，年龄 24.6±4.5 岁（16-31 岁）。6 例为双侧受累。经背侧入路安装 Orthofix 外固定器微轨，第四跖趾关节用克氏针临时固定。在近端跖骨行微创截骨后进行骨延长。记录美国矫形足踝协会（AOFAS）小跖趾关节-趾间关节（MTP-IP）评分、跖骨长度、并发症。采用配对 t 检验比较术前和术后 AOFAS MTP-IP 评分。
患者平均随访 55±10.8 个月。术前第四跖骨平均长度为 49.9±2.9mm，平均跖骨缩短 18.8±3.1mm，平均延长 19.8±3.3mm，延长率 39.7%±6.6%。术后 3-4 个月，延长的骨痂完全骨化。所有患者均对延长效果满意。AOFAS 评分由术前 83.7±4.2 分显著提高至术后 93.2±2.7 分（t=-10.27，p<0.001）。1 例创伤性跖趾关节半脱位患者行关节复位克氏针固定，1 例跖趾关节屈曲挛缩患者行关节松解克氏针固定。6 例患者经伤口护理和抗生素治疗控制了针道感染。所有患者均无骨不连、脚趾坏死和脚趾感觉障碍。
外固定器微创截骨跖骨延长术治疗先天性短趾畸形效果满意。
