一期延长髂骨植骨治疗第一跖骨短小症
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摘要
目的探讨一期延长髂骨植骨治疗第一跖骨短小症的临床疗效,并介绍该手术方式的优点。方法采用第一跖骨背侧切口,于跖骨中段用摆锯将跖骨截断,一期延长取髂骨植骨。结果本组5例患者获术后随访6～18个月,术后12周时X线片示5例跖骨均达到骨性愈合,延长长度1.2～2.2 cm,平均1.7 cm。按照美国足踝矫形外科协会(American orthopedic foot and ankle society, AOFAS)的功能评判标准,术后AOFAS评分平均为87.5分,3例优,2例良。无明显并发症发生,所有患者对延长结果、外形及足功能恢复满意或基本满意。结论一期延长髂骨植骨治疗第一跖骨短小症能使跖骨恢复到满意的长度,且恢复较快,并发症较少,值得临床推广应用。
Objective To explore the clinical efficacy of one-stage prolongation bone graft in the treatment of first metatarsal shortness and to introduce the advantages of this surgical method. Methods The middle part of the metatarsal bone was cut off with a swing saw through the dorsal incision of the first metatarsal bone. The iliac bone was obtained for one-stage prolongation bone graft. Results All patients were followed up from 6 to 18 months. The postoperative radiographs showed that bony union was achieved in all metatarsals at 12 weeks. The average prolongation length was 1.7 cm(from 1.2 to 2.2 cm). Function was evaluated according to the standard of the American Orthopedic Foot and Ankle Society(AOFAS). The average postoperative AOFAS score was 87.5, 3 were excellent,and 2 were good. No obvious complications were found. All patients were satisfied with the prolongation results, appearance, and recovery of function in the feet. Conclusion Treatment of first metatarsal shortness with one-stage prolongation using iliac bone graft can restore the metatarsal bone to a satisfactory length. This method has a short recovery period, and complications are rare, making this procedure worth popularizing and applying in clinic.
Objective To explore the clinical efficacy of one-stage prolongation bone graft in the treatment of first metatarsal shortness and to introduce the advantages of this surgical method. Methods The middle part of the metatarsal bone was cut off with a swing saw through the dorsal incision of the first metatarsal bone. The iliac bone was obtained for one-stage prolongation bone graft. Results All patients were followed up from 6 to 18 months. The postoperative radiographs showed that bony union was achieved in all metatarsals at 12 weeks. The average prolongation length was 1.7 cm(from 1.2 to 2.2 cm). Function was evaluated according to the standard of the American Orthopedic Foot and Ankle Society(AOFAS). The average postoperative AOFAS score was 87.5, 3 were excellent,and 2 were good. No obvious complications were found. All patients were satisfied with the prolongation results, appearance, and recovery of function in the feet. Conclusion Treatment of first metatarsal shortness with one-stage prolongation using iliac bone graft can restore the metatarsal bone to a satisfactory length. This method has a short recovery period, and complications are rare, making this procedure worth popularizing and applying in clinic.
引文
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[7]KIM H S,LEE Y S,JUNG J H,et al.Complications of distraction osteogenesis in brachymetatarsia:comparison between the first and fourth brachymetatarsia[J].Foot Ankle Surg,2019,25(2):113-118.
[8]LEE K B,YANG H K,CHUNG J Y,et al.How to avoid complications of distraction osteogenesis for first brachymetatarsia[J].Acta Orthop,2009,80(2):220-225.
[9]HAMADA M,SAKAMOTO Y,NAGASAO T,et al.Treatment of complications after distraction osteogenesis for brachymetatarsia of the fourth metatarsal[J].Plast Reconstr Surg Global open,2016,4(7):e817.
[10]LEE W C,YOO J H,MOON J S.Lengthening of fourth brachymetatarsia by three different surgical techniques[J].J Bone Joint Surg Br,2009,91(11):1472-1477.
[11]JONES M D,PINEGAR D M,RINCKER S A.callus distraction versus single-stage lengthening with bone graft for treatment of brachymetatarsia:a systematic review[J].J Foot Ankle Surg,2015,54(5):927-931.
[12]LEE K B,PARK H W,CHUNG J Y,et al.Comparison of the outcomes of distraction osteogenesis for first and fourth brachymetatarsia[J].J Bone Joint Surg Am,2010,92(16):2709-2718.
[13]LEE W C,SUH J S,MOON J S,et al.Treatment of brachymetatarsia of the first and fourth ray in adults[J].Foot Ankle Int,2009,30(10):981-985.
[2]WAIZYH,POLZER H,SCHIKORAN,et al.One-stage metatarsal interposition lengthening with an autologous fibula graft for treatment of brachymetatarsia[J].Foot Ankle Spec,2018 Oct 3.
[3]KUMAR P,PILLAI A,BATE J A,et al.Distraction osteogenesis for brachymetatarsia using initial circular fixator and early transfixation metatarsal K-wires-a series of three cases(dagger)[J].Journal of Surgical Case Reports,2018(10):269.
[4]MUNUERA MARTINEZ P V,LAFUENTE SOTILLOS G,DOMINGUEZ MALDONADO G,et al.Morphofunctional study of brachymetatarsia of the fourth metatarsal[J].J Am Podiatric Med Assoc,2004,94(4):347-352.
[5]KIM H T,HONG S M,KIM I H.Treatment of brachymetatarsia involving the great toe[J].JB JS Open Access,2018,3(2):e0046.
[6]KIM J S,BAEK G H,CHUNG M S,et al.Multiple congenital brachymetatarsia.A one-stage combined shortening and lengthening procedure without iliac bone graft[J].J Bone Joint Surg Br,2004,86(7):1013-1015.
[7]KIM H S,LEE Y S,JUNG J H,et al.Complications of distraction osteogenesis in brachymetatarsia:comparison between the first and fourth brachymetatarsia[J].Foot Ankle Surg,2019,25(2):113-118.
[8]LEE K B,YANG H K,CHUNG J Y,et al.How to avoid complications of distraction osteogenesis for first brachymetatarsia[J].Acta Orthop,2009,80(2):220-225.
[9]HAMADA M,SAKAMOTO Y,NAGASAO T,et al.Treatment of complications after distraction osteogenesis for brachymetatarsia of the fourth metatarsal[J].Plast Reconstr Surg Global open,2016,4(7):e817.
[10]LEE W C,YOO J H,MOON J S.Lengthening of fourth brachymetatarsia by three different surgical techniques[J].J Bone Joint Surg Br,2009,91(11):1472-1477.
[11]JONES M D,PINEGAR D M,RINCKER S A.callus distraction versus single-stage lengthening with bone graft for treatment of brachymetatarsia:a systematic review[J].J Foot Ankle Surg,2015,54(5):927-931.
[12]LEE K B,PARK H W,CHUNG J Y,et al.Comparison of the outcomes of distraction osteogenesis for first and fourth brachymetatarsia[J].J Bone Joint Surg Am,2010,92(16):2709-2718.
[13]LEE W C,SUH J S,MOON J S,et al.Treatment of brachymetatarsia of the first and fourth ray in adults[J].Foot Ankle Int,2009,30(10):981-985.