Doctorate School, Valencia Catholic University "San Vicente Mártir", Valencia, Spain.
Research Group in Musculoskeletal Pathology of Lower Limbs, Valencia Catholic University, Valencia, Spain.
BMC Musculoskelet Disord. 2024 Oct 4;25(1):784. doi: 10.1186/s12891-024-07885-1.
Lengthening of the extensor hallucis longus (EHL) is performed to address various forefoot pathologies. The retraction of this tendon is strongly associated with the Hallux Abductus Valgus (HAV) deformity. Minimally Invasive Surgery (MIS) lengthening of the EHL is carried out in combination with other surgical techniques for HAV bone realignment. It is performed without ischemia, using local anesthesia and sedation if required by the patient. One of the advantages of this technique is immediate ambulation with a postoperative shoe without the need for a cast. The objective of the research was to demonstrate the efficacy and safety of the minimally invasive technique for lengthening the tendon in patients with HAV.
The procedures were performed on 11 fresh cryopreserved cadaveric feet. HAV surgery was performed through dorsomedial and dorsolateral portals for Reverdin-Isham, Akin and adductor tenotomy. In addition, EHL tendon elongation was performed using the Beaver 67 MIS scalpel through an incomplete zigzag tenotomy. The specimens used did not present any type of disease nor had they undergone previous surgeries that could affect the technique. First, the plantar flexion of the metatarsophalangeal joint was measured with a goniometer to establish the degrees of this joint before proceeding with the technique, the tenotomy was performed and remeasured and finally the osteotomy was performed. In addition, an anatomical dissection of cadaveric specimens was performed and various anatomical and surgical relationships were analyzed and measured.
The data indicate that, after performing zigzag tenotomy, there is an average improvement of 13.91 degrees in plantar flexion.
The study confirms the effectiveness and safety of elongating the extensor hallucis longus tendon of the hallux using minimally invasive surgery. The zigzag technique for tendon elongation may be considered a viable minimally invasive treatment option for addressing tendon hyperextension in patients with HAV.
为了解决各种前脚病变，通常会对伸肌肌腱（EHL）进行延长。该肌腱的回缩与拇趾外展（HAV）畸形强烈相关。微创 EHL 延长术与其他 HAV 骨骼矫正手术技术相结合。如果患者需要，可以在局部麻醉和镇静下进行，无需缺血。该技术的优势之一是患者术后可以立即穿着术后鞋行走，而无需使用石膏固定。本研究的目的是证明微创技术在治疗 HAV 患者的肌腱延长方面的有效性和安全性。
11 只新鲜冷冻的尸体足部进行了该手术。HAV 手术通过背侧内侧和背侧外侧入路进行，用于 Reverdin-Isham、Akin 和内收肌腱切开术。此外，通过 Beaver 67 MIS 手术刀进行不完整的之字形肌腱切开术，对 EHL 肌腱进行延长。使用的标本没有任何类型的疾病，也没有进行过可能影响该技术的先前手术。首先，使用量角器测量跖趾关节的跖屈角度，以确定在进行该技术之前该关节的角度，然后进行肌腱切开术并重新测量，最后进行骨切开术。此外，还对尸体标本进行了解剖学解剖，分析和测量了各种解剖和手术关系。
数据表明，进行之字形肌腱切开术后，跖屈平均改善 13.91 度。
该研究证实了微创延长拇长伸肌腱治疗 HAV 的有效性和安全性。肌腱延长的之字形技术可能是治疗 HAV 患者肌腱过度伸展的一种可行的微创治疗选择。
