Brunet J A
Division of Orthopedic Surgery, University of Ottawa, Ottawa General Hospital, Ontario, Canada.
Clin Orthop Relat Res. 1996 Nov(332):126-31. doi: 10.1097/00003086-199611000-00017.
Because only 10 complex dislocations of the first metatarsophalangeal joint have been reported to date, a retrospective review was initiated to study the pathomechanics of 11 new cases (9 patients) and to report on the clinical and functional outcomes. Concomitant ipsilateral injuries were frequent: 6 tarsometatarsal joint partial disruptions and 8 cases with multiple midfoot or forefoot fractures or dislocations occurred. Clinical and radiographic assessments suggested that forefoot hyperextension combined with axial loading of the foot in a heel to toe or toe to heel direction produced all. Six cases required open reductions (5 were compound), and 5 cases were managed by closed methods. Associated tarsometatarsal joint disruptions facilitated closed management. The most common complaints at followup assessment (average, 7 years) were sensitive plantar wounds, partial joint ankylosis, and sesamoid sensitivity. All but 1 patient resumed the same or modified work. The data in this series suggest that most complex dislocations of the first metatarsophalangeal joint probably occur frequently with a concurrent tarsometatarsal joint sprain or disruption, and that the primary mechanism of injury is that of axial loading of the foot causing midfoot hyperflexion and forefoot hyperextension. Contrary to current opinion, not all complex dislocations of the first metatarsophalangeal joint are resistant to closed management.
由于迄今为止仅报道过10例第一跖趾关节复杂脱位，因此开展了一项回顾性研究，以探讨11例新病例（9名患者）的发病机制，并报告临床和功能结局。同侧合并伤很常见：发生了6例跗跖关节部分断裂，以及8例伴有多处中足或前足骨折或脱位的病例。临床和影像学评估表明，前足过度伸展并伴有足在足跟至足尖或足尖至足跟方向的轴向负荷导致了所有这些损伤。6例需要切开复位（5例为开放性骨折），5例采用闭合方法处理。合并的跗跖关节断裂有助于采用闭合治疗。随访评估（平均7年）时最常见的主诉是足底伤口敏感、关节部分强直和籽骨敏感。除1名患者外，所有患者都恢复了原工作或调整后的工作。本系列数据表明，大多数第一跖趾关节复杂脱位可能常伴有跗跖关节扭伤或断裂，损伤的主要机制是足部轴向负荷导致中足过度屈曲和前足过度伸展。与目前观点相反，并非所有第一跖趾关节复杂脱位都难以采用闭合治疗。
