改良Weil截骨手术治疗第2-5跖趾关节脱位的疗效评估

Modified Weil osteotomy for treatment of dislocated lesser metatarsophalangeal joints

背景:Weil截骨术常用于治疗第2-5跖趾关节半脱位或脱位引起的跖痛症,但也经常出现并发症。目的:探讨改良Weil截骨术治疗第2-5跖趾关节脱位畸形的疗效。方法:2009年至2011年采用改良Weil截骨术治疗第2-5跖趾关节脱位畸形32足,行45趾截骨。男10足,女22足。患足手术前后常规拍摄足正侧位X线片,测量跖骨长度,使用美国足踝外科协会(AOFAS)趾-跖趾-趾间关节评分系统评估临床疗效。结果:Weil截骨术后跖趾关节畸形恢复正常关系43例,AOFAS评分术前(48.6±7.5)分,术后(85.9±6.5)分;跖骨截骨后短缩2～7mm,平均4.3mm。2例浮趾畸形,经保守治疗好转。2例复位后仍有半脱位。1例可折断钉过长疼痛。结论:改良Weil截骨能有效纠正第2-5跖趾关节脱位,临床疗效满意。

Background： The Weil osteotomy is commonly used for dislocated lesser metatarsophangeal （MTP） joints pathologies yield- ing metatarsalgia. And Weil osteotomy is associated with a high complication rate. Objective： To evaluate the clinical outcomes of modified Weil osteotomy for dislocated lesser MTP joints. Methods： Between 2009 and 2011, 45 modified metatarsal Weil osteotomies for correction of dislocated lesser MTP joints were performed in 32 patients. Weight-bearing anterior-posterior and lateral X ray were taken before the surgery and after surgery on follow up. The length of the metatarsal bone was measured on the X-ray film. AOFAS system was used to evalu- ate therapeutic effect. Results： 43 MTP joints were restored to normal alignment after surgery. AOFAS score was 48.6±7.5 befor surgery, and 85.9±6.5 after surgery;significant difference was found between the result. The metatarsl bone was shortened by 2-7 mm （mean 4.3 mm） after Modified Weil osteotomy. Floating toe occurred in 2 cases. Subluxation joint still exised in 2 joints af- ter restoration, plantar penetrating hardware occurred in one case. Conclusions： Modified Weil osteotomy at lesser metatarsal joints can effectively treat metarsalgia caused by dislocation of the MTP joint.