侧副韧带和跖板对跖趾关节屈曲功能的影响

THE EFFECT OF THE PLANTAR PLATE AND THE COLLATERAL LIGAMENTS ON THE FLEXION OF THE METATARSOPHALANGEAL JOINTS

目的 探讨侧副韧带、跖板对跖趾关节屈曲功能的影响。方法 取成人尸体第2～4足趾，共24趾。按切断双侧侧副韧带和跖板的不同顺序均分为A、B两组（n=-12），A组先切断双侧侧副韧带，再切断跖板薄弱部分，B组按相反顺序切断，观察不同顺序切断前后相同负荷下跖趾关节屈曲角度的变化。并于1994年5月～2000年7月，应用第2足趾游离跖趾关节复合组织移植重建第2和第3掌指关节11例，其中2例行跖板切除术，另9例行跖板＋双侧侧副韧带切除术。结果 A组，术前跖趾关节屈曲角度为37．30±5．42°，切断双侧侧副韧带后屈曲角度增加11.29±2．36°，达48．60±2．98°，与切断前比较差异有统计学意义（P〈0．01）；再次切断跖板后，屈曲角度增加5．30±1．59°，达53．35±2．76°，与切断前比较差异有统计学意义（P〈0．01）。B组，术前跖趾关节屈曲角度为34．59±5．32°，切断跖板后屈曲角度增加6．29±2．98°，达40．89±2．36°，与切断前比较差异有统计学意义（P〈0．01）；再次切断双侧侧副韧带后，屈曲角度增加9．71±1.94°，达50．60±2．01°，与切断前比较差异有统计学意义（P〈0．01）。切断双侧侧副韧带与切断跖板比较，前者更能增加跖趾关节的屈曲角度（P〈0、01），二者切断的先后顺序对总屈曲角度改变影响无统计学意义（P〉0、05）。临床应用后随访显示，仅切断跖板者经2个月随访，屈曲角度为15～45°；切断跖板＋双侧侧副韧带者经26．3个月随访，屈曲角度为10．3～58．4°。结论 切断双侧侧副韧带及跖板可增加跖趾关节屈曲角度。

Objective To explore the effect of the collateral ligaments and the plantar plate on the flexion of the metatarsophalangeal （MP） joints. Methods Twenty-four preserved human No. 2-4 digits were obtained from embalmed cadaver feet, which were divided into 2 groups at random. In group A, the bilateral collateral ligaments were cut first, and then the plantar plate was sectioned. They were cut in opposite sequence in group B. Angle of the flexion of MP joint was observed in the same load after the bilateral collateral ligaments and the plantar plate were sectioned in different sequence. From 1994 to 2000,11 cases were used with this technic, including plantar section in 2 cases and both plantar section and bilateral collateral ligaments cut in 9 cases. Results The angle of flexion of the MP joint before operation in group A is 37.30±5.42°, it increased 11.29±2.36° and to 48.60±2.98° when the bilateral collateral ligaments were cut, and there was significant difference. Later the cut of the plantar plate increased another 5.30±1.59° and to 53.35±2.76°. Both have an increasing trend for the angle of flexion of the MP joint （P〈0.01）. While in group B, the angle of flexion of the MP joint before operation is 34.59±5.32°, it increased 6.29±2.98° and to 40.8±9 2.36° when the plantar plate were cut, later the cut of the bilateral collateral ligaments increased another 9.71±1.94° and to 50.60±2.01°. Both had an increasing trend for the angle of flexion of the MP joint （P〈0.01）. The bilateral collateral ligaments had more influence than the plantar plate （P〈0.01）. There was the same effect in different sequence （P）0.05）. In 2 cases with plantar section, the flexion angle of MP joint could achieve 15° to 45° in 2 monthes. The other 9 cases with both plantar section and bilateral collateral ligaments cut, the MP joint flexion achieved 10.3° to 58.4° in 26.3 months. Conclusion The flexion angle of the MP joint can be increased by cutting the bilateral collateral ligaments and the plantar plate.