Domingues Liliana S, Norte Susana, Thusing Mónika, Neves Manuel C
Unidade de Ortopedia Infantil, Hospital CUF Descobertas, Lisboa.
Serviço de Ortopedia, Hospital Sant'Iago do Outão, Setúbal, Portugal.
J Pediatr Orthop B. 2025 Mar 1;34(2):151-156. doi: 10.1097/BPB.0000000000001209. Epub 2024 Sep 23.
The objective of this study is to describe and evaluate dorsal hemiepiphysodesis of the first metatarsal as an osteotomy replacement technique. Retrospective analysis of patients with pes cavovarus (PCV) treated in our center with dorsal hemiepiphysodesis of the first metatarsal. Meary's angle, calcaneal pitch, and Moreau Costa Bartani were compared pre and post-operatively and the ratio between width and foot length was monitored. Between May 2012 and May 2022, eight patients (14 feet) with PCV underwent dorsal hemiepiphysiodesis of the first metatarsal combined with the Steindler procedure. Four patients (50%) were male. The average age for boys at surgery was 10.75 years (10-11) and for girls was 9.75 years (8-11). Most patients (87.5%) had idiopathic PCV and 12.5% had a neurological PCV. Median follow-up was 4.3 years (1.5-10) and a benefit was seen in all patients in Moreau Costa Bartani angle (112.64° vs. 120.59°; P value = 0.003), calcaneal pitch (26.48° vs. 25.36°; P value = 0.091) and Meary's angle (10.60° vs. 5.36°; P value = 0.008) after surgery. Supination improvement was also shown (0.21 vs. 0.24; P value = 0.039). Despite the limited number of patients, the results demonstrated that dorsal hemiepiphysiodesis of the first metatarsal can be a valid alternative to osteotomy of the base of the first metatarsal, with less morbidity and a gradual and dynamic correction throughout growth.
本研究的目的是描述和评估第一跖骨背侧半骨骺阻滞术作为一种截骨替代技术。对在我们中心接受第一跖骨背侧半骨骺阻滞术治疗的高弓足畸形患者进行回顾性分析。术前和术后比较了梅里角、跟骨倾斜度和莫罗·科斯塔·巴尔塔尼角，并监测了足宽与足长的比例。2012年5月至2022年5月，8例（14足）高弓足畸形患者接受了第一跖骨背侧半骨骺阻滞术联合施泰德勒手术。4例（50%）为男性。男孩手术时的平均年龄为10.75岁（10 - 11岁），女孩为9.75岁（8 - 11岁）。大多数患者（87.5%）为特发性高弓足畸形，12.5%为神经性高弓足畸形。中位随访时间为4.3年（1.5 - 10年），所有患者术后莫罗·科斯塔·巴尔塔尼角（112.64°对120.59°；P值 = 0.003）、跟骨倾斜度（26.48°对25.36°；P值 = 0.091）和梅里角（10.60°对5.36°；P值 = 0.008）均有改善。旋后改善情况也有显示（0.21对0.24；P值 = 0.039）。尽管患者数量有限，但结果表明，第一跖骨背侧半骨骺阻滞术可作为第一跖骨基底截骨术的有效替代方法，具有较低的发病率，且在整个生长过程中能进行渐进性和动态性矫正。
