测量第一、二跖骨长度的临床意义

The Clinical Significance of Measuring the Length of the First and Second Metatarsals

本文测量了１０４个正常足和１５个外翻足正位Ｘ线片的第一、二跖骨长度。正常第一跖骨长度，男性平均５９．４ｍｍ，女性平均５５ｍｍ。第二跖骨长度，男性平均６０．８ｍｍ，女性平均６３．６ｍｍ。第二跖骨与第一跖骨长度差，男性平均９．１ｍｍ，女性平均８．４ｍｍ。差值在５ｍｍ以下者，男性为２１％，女性为２％。外翻足第一跖骨长度，男性平均５７．５ｍｍ，女性平均５４．８ｍｍ。第二跖骨长度，男性平均６６．５ｍｍ，女性平均６１．７ｍｍ。第二跖骨与第一跖骨长度差在５ｍｍ以下者占３３％。无论是正常足还是外翻足，无一例第一跖骨长于第二跖骨。本文提示：纠正外翻时，尽量不要使第一跖骨短缩，对第二与第一跖骨长度差值大于５ｍｍ以上者，尽量避免在第一跖骨干截骨。同时提出，在第一跖楔关节处截骨，可减少并发症发生。

The authors measured the lengths of the first and the second metatarsals on the A-P view of X-ray films of 119 feet, of which 104 were normal and 15 had hallux valgus deformity. Normally the average length of the first metatarsal was 59.4mm in the male and 55mm in the female and that of the second metatarsal were 60.8mm and 63.6mm respectively for the males and the females.There was a difference between the first and the second metatarsals of 9.1mm and 8.4mm respectively in the males and the females; in 21% of the males, and 22% of the females the difference of the length of the first and the second metatarsals was less than 5 mm. In the feet with hallux valgus, the length of the first metatarsal was in average 57.5mm in the male and 54.8mm in the female, and that of the second metatarsal measured 66.5mm in the males and 61.7mm in the females. In 33% of the cases, the difference in length in between the first and the second metatarsals was less than 5mm. A longer first metatarsal than the second was seen in none. The authors proposed that, during the surgical procedure for the correction of hallux valgus deformity, the first metatarsal should not be shortened and that, osteotomy at the lever of the first tarsometatarsal joint level reduced most of the complication of hallux valgus surgery.