Zhang Jiadong, Zhang Ning, Huang Zheng, Wang Yang, Xu Wenpeng, Hu Yong
Department of Hand Surgery/Foot and Ankle Surgery, the Second Qilu Hospital of Shandong University, Foot and Ankle Research Center of Shandong University, Jinan Shandong, 250033, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Aug 15;39(8):1020-1024. doi: 10.7507/1002-1892.202505022.
To evaluate the functional and aesthetic evaluation of external fixator lengthening through plantar approach for fourth brachymetatarsia.
A retrospective analysis was conducted on 20 patients (23 feet) with fourth brachymetatarsia who met the selection criteria between January 2016 and January 2024, including 3 males and 17 females, with 8 left, 9 right, and 3 bilateral cases. The mean age was 24.7 years (range, 14-51 years). The preoperative metatarsal shortening length was (13.8±3.2) mm. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was 79.5±3.9, the visual analogue scale (VAS) score of appearance satisfaction was 1.7±0.8, and the appearance index (AI) score was 13.6±0.9. All patients underwent external fixator lengthening through plantar approach. The lengthening length of metatarsal bone, lengthening ratio, healing time, and healing index were recorded. Functional outcomes were assessed using the AOFAS forefoot score, VAS score of appearance satisfaction, and quality-of-life impact with AI questionnaire.
All 20 patients were followed up 14-55 months with an average of 36.3 months. During the follow-up, complications occurred in 4 cases (17.4%), including 2 cases of metatarsophalangeal joint stiffness, which had no significant effect on the function and appearance. Delayed union of osteotomy occurred in 1 case (healed at 12 weeks after operation). Pin loosening occurred in 1 case and recovered after outpatient reinforcement. No complications related to plantar scar occurred. At last follow-up, the lengthening length of metatarsal bone was (13.9±3.1) mm, and the lengthening ratio was 25.8%±5.6%. All cases achieved bony union, with a mean healing time of (64.3±12.5) days and a healing index of (46.9±4.8) d/cm. At last follow-up, AOFAS score was 98.9±2.1, the VAS score of appearance satisfaction was 9.3±0.7, and the AI score was 0.6±0.8, which significantly improved when compared with those before operation ( =27.398, <0.001; =32.994, <0.001; =56.135, <0.001).
External fixator lengthening through plantar approach is a safe and effective technique for fourth brachymetatarsia, achieving satisfactory functional and aesthetic outcomes.
评估经足底入路外固定器延长治疗第四跖骨短小症的功能及美学效果。
对2016年1月至2024年1月间符合入选标准的20例（23足）第四跖骨短小症患者进行回顾性分析，其中男性3例，女性17例，左侧8例，右侧9例，双侧3例。平均年龄24.7岁（范围14 - 51岁）。术前跖骨缩短长度为（13.8±3.2）mm。术前美国矫形足踝协会（AOFAS）前足评分为79.5±3.9，外观满意度视觉模拟量表（VAS）评分为1.7±0.8，外观指数（AI）评分为13.6±0.9。所有患者均接受经足底入路外固定器延长术。记录跖骨延长长度、延长率、愈合时间及愈合指数。采用AOFAS前足评分、外观满意度VAS评分及AI问卷评估生活质量影响来评价功能结局。
20例患者均获随访，随访时间14 - 55个月，平均36.3个月。随访期间，4例（17.4%）出现并发症，其中2例跖趾关节僵硬，对功能和外观无明显影响。1例截骨延迟愈合（术后12周愈合）。1例出现克氏针松动，门诊加固后恢复。未发生与足底瘢痕相关的并发症。末次随访时，跖骨延长长度为（13.9±3.1）mm，延长率为25.8%±5.6%。所有病例均达到骨性愈合，平均愈合时间为（64.3±12.5）天，愈合指数为（46.9±4.8）d/cm。末次随访时，AOFAS评分为98.9±2.1，外观满意度VAS评分为9.3±0.7，AI评分为0.6±0.8，与术前相比均显著改善（ =27.398，<0.001； =32.994，<0.001； =56.135，<0.001）。
经足底入路外固定器延长术治疗第四跖骨短小症是一种安全有效的技术，可获得满意的功能及美学效果。
