改良Weil截骨治疗第二跖骨头坏死

Modified Weil osteotomy for necrosis of the second metatarsal head

目的评估改良Weil截骨术治疗第二跖骨头坏死的疗效及价值。方法在临近跖骨颈的关节软骨背侧与跖骨轴线呈25°～30°在冠状面截骨;根据术前设计,距第一截骨线3～5mm的近侧做第二截骨,两个截骨面顶点相同,位于跖侧,完成楔形截骨;去除楔形骨块,将截骨远端跖骨头轻轻抬起,闭合截骨面用小皮质骨螺钉做可靠内固定;合并垂状趾后行远侧趾间关节融合。结果患者均获得随访,随访时间4～32个月,平均15个月。切口均I/甲愈合,骨愈合良好,畸形改善,疼痛消失。2例截骨过多,1例出现漂浮趾,1例出现转移性跖骨痛。按美国足踝骨科协会(AOFAS)评分为88.6分,优良率93.1%。结论改良Weil截骨术治疗第二跖骨头坏死是一种有效的方法,成功关键是术前必须详细了解患者的症状和影像学资料,进行细致的手术设计,准备好配套的微型摆锯。

Objective To evaluate the efficacy and value of the modified Weil osteotomy for necrosis of the second metatarsal head. Methods Osteotomy was performed on the coronal plane in the dorsal stream of the articular cartilage near the metatarsal neck. The coronal plane formed an angle between 25°and 30°with the metatarsal axis. According to preoperative planning, the second osteotomy was performed 3 to 5 mm proximal to the first osteotomy line. The peaks of both procedures were the same on the plantar side. Wedge osteotomy was completed. With removal of the wedge bone, metatarsal head on the distal side of the excision was gently raised and fixed with a small cortical bone screw. Distal interdigital joint fusion was performed in combination with the vertical toe. Results All patients were followed up for 4 to 32 months, 15 on average. The cut was clean, and healed well. The bone healing was good; the deformity was corrected; and the pain was gone. 2 patients had excessive osteotomy; 1 had floating toe; and 1 had metastatic metatarsal pain. The American Orthopaedic Foot and Ankle Society Press （AOFAS） score was 88.6 points. The ratio of excellent and good results was 93.1%. Conclusions The modified Weil osteotomy is an effective method for necrosis of the second metatarsal head. The key to a successful surgery is good understanding of the patient＇s symptoms and imaging data before surgery, meticulous operation planning, and the preparation of a mini-pendulum saw.