跖腱膜对第1跖趾关节活动的影响

Experimental study of relationship between plantar fascia and motion range of first metatarsophalangeal joint

目的认识跖腱膜对维持第1跖趾关节稳定性的作用,探讨早期僵硬手术治疗的可行性。方法采用6例新鲜尸体足标本,固定于自制生物力学加载支架,用逐级定量的方法对第1跖趾关节进行力学加载,测量跖腱膜离断前后第1跖趾关节背屈活动范围的变化。结果跖腱膜离断前第1跖趾关节背屈为(68.34±3.05)°,跖腱膜离断后背屈为(78.50±3.77)°,较离断前增加了(10.16±2.10)°(t=11.83,P<0.05)。结论跖腱膜对维持第1跖趾关节稳定有重要作用,损伤后要尽可能修复;某些足部疾病的治疗如需离断跖腱膜,尽量做部分离断;跖腱膜切开术可能是治疗早期拇僵硬可以选择的一种手术方法。

Objective To reveal the importance that the plantar fascia takes to the stability maintenance of the first metatarsophalangeal joint and to investigate the feasibility of treating Hallux rigidus in its early stage through surgery. Mothods 6 fresh cadaveric foot specimens were used in the experiment. A digital detective device was adopted to measure the motion range of the first metatarsophalangeal joint before and after the severance of the plantar fascia beneath the first metatarsal bone. During the measuring process, the distal end of the hallux was loaded to dorsiflexion with the whole specimen fixed to homemade braces. Rosttlts The dorsiflexion range of the first metatarsophalangeal joint was （68.34±3.05）°and （78.50±3.77）° before and after the severance of the plantar fascia, respectively. The motion range increased by （ 10.16±2.10）°after the plantar fascia was severed （t=1 1.83, P〈0.05）. Conclusion The plantar fascia plays an important role in maintaining the stability of the first metatarsophalangeal joint. The injury of the plantar fascia should be treated in its earliest stage possible. Surgical release of the plantar fascia should be well-planned to minimize the effect on its structural and functional integrity. Partial section of plantar fascia may be used as an effective operative approach to deal with Hallux rigidus in its early stage.