| 顾建明,杜辉,崔雅南,等.微创截骨单臂架骨延长术治疗先天性跖骨短小症.骨科,2021,12(3): 195-199. |
| 微创截骨单臂架骨延长术治疗先天性跖骨短小症 |
| Bone lengthening with monolateral external fixation by minimally invasive osteotomy in the treatment of congenital brachymetatarsia |
| 投稿时间：2021-02-23 |
| DOI：10.3969/j.issn.1674-8573.2021.03.002 |
| 中文关键词: 外固定架 伊利扎罗夫技术 跖骨短小 跖骨延长 微创 截骨 |
| 英文关键词: External fixation Ilizarov technique Congenital brachymetatarsia Metatarsal lengthening Minimally invasive operation Osteotomy |
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| 中文摘要: |
| 目的 探讨微创截骨单臂架骨延长术治疗先天性跖骨短小症的临床效果。方法 回顾性分析2016年9月至2020年7月在北京积水潭医院矫形骨科应用外固定架治疗的9例跖骨短小症病人的临床资料，其中男1例，女8例，年龄为（24.5±4.2）岁（18~31岁），共14足，均为第四趾短小，其中4例为单侧，5例为双侧受累。使用背侧入路安装Orthofix外固定mini轨道支架，临时固定第四跖趾关节，微创截骨后进行骨延长。记录病人手术前后美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society，AOFAS）评分、跖骨长度和并发症发生情况。结果 病人均获得随访，随访时间为（25.1±16.6）个月（6~53个月）。病人术前第四跖骨长度为（47.9±4.9） mm，跖骨短缩（15.6±2.4） mm（12~20 mm），术后延长（16.5±3.5） mm（12~23 mm），延长比例为34.9%±8.3%。延长骨痂在术后3~4个月完全骨化，带外固定架时间为（3.5±0.5）个月。病人对足部外观满意，AOFAS评分从术前（86.2±3.9）分恢复到术后（93.4±3.9）分，差异有统计学意义（t=-7.126，P＜0.001）。1例病人因外伤后皮肤裂伤，跖趾关节半脱位，行外固定架拆除、清创缝合、关节复位、克氏针固定。1例病人因跖趾关节屈曲挛缩，行关节松解复位、克氏针固定术。6例病人有针道感染，经换药以及抗生素治疗后控制，无深部感染发生。所有病人无骨不连，足趾坏死，以及足趾感觉障碍的情况。结论 微创截骨单臂架跖骨延长术手术创伤小，可以获得满意的疗效，尤其适用于治疗短缩超过15 mm的先天性跖骨短小症病人。 |
| 英文摘要: |
| Objective To investigate the effect of bone lengthening with monolateral external fixation by minimally invasive osteotomy in the treatment of congenital brachymetatarsia. Methods A retrospective study was conducted on patients with congenital brachymetatarsia treated by metatarsal lengthening in Beijing Jishuitan Hospital from September 2016 to July 2020. There were 9 patients with 14 shorted fourth metatarsals, including 8 females and 1 male, with age of (24.5±4.2) years (18-31 years). Four patients were bilaterally involved. Orthofix external fixator mini track was installed through dorsal approach and the fourth metatarsal-phalangeal joints were temporarily fixed by Kirschner wire. Bone lengthening was performed after a minimally invasive osteotomy at the proximal metatarsals. American Orthopaedic Foot and Ankle Society (AOFAS) scores, metatarsal length, complications were recorded. Results Patients were followed up for (25.1±16.6) months. The mean length of the 4th metatarsal bone was (47.9±4.9) mm preoperatively. The mean metatarsal shortage was (15.6±2.4) mm (12-20 mm). The mean lengthening achieved was (16.5±3.5) mm (12-23 mm), with a lengthening ratio of 34.9%±8.3%. The lengthened callus ossified completely at 3-4 months after operation. All patients were satisfied with the results of lengthening. The AOFAS scores were improved significantly from 86.2±3.9 preoperatively to 93.4±3.9 postoperatively (t=-7.126, P＜0.001). One patient with traumatic metatarsophalangeal joint subluxation was treated by joint reduction and Kirschner wire fixation. One patient had metatarsophalangeal joint release and Kirschner wire fixation due to flexion contracture. Pin tract infections were controlled by wound care and antibiotics in 6 patients. All patients had no nonunion, necrosis of toes, and sensory disturbance of toes. Conclusion Metatarsal lengthening by minimally invasive osteotomy with monolateral external fixator had satisfactory results in the treatment of congenital brachymetatarsia. |
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