跖板修补联合Weil截骨治疗慢性跖趾关节不稳

Plantar plate repair with Weil osteotomy for chronic instability of the lesser metatarsophalangeal joint

目的 评价跖板修补联合Weil截骨治疗慢性跖趾关节不稳的临床疗效.方法 回顾性分析2012年2月至2013年1月收治的慢性跖趾关节不稳患者19例19足,男1例,女18例;年龄51～65岁,平均57岁.损伤根据Coughlin分型：1度3例,2度5例,3度9例,4度2例.18例累及第2跖趾关节,1例为第2、3跖趾关节同时发病.使用Weil截骨短缩抬高跖骨头,同时探查跖板,17例行跖板修复,2例因跖板缺损严重而行趾长屈肌腱转位术.术后采用美国骨科足踝外科协会（AOFAS）外侧足趾评分及视觉模拟评分（VAS）评估临床疗效.结果 16例患者入选进行最终统计分析,随访时间为12～24个月（平均18个月）.所有患者临床症状明显改善,术后足趾畸形获得矫正,跖趾关节抽屉试验阴性,影像学检查跖趾关节力线获得纠正.末次随访时AOFAS外侧足趾评分[（83.4±8.7）分]和VAS评分[（1.3±0.9）分]均较术前[（40.7±6.9）分和（6.8±1.2）分]改善,差异有统计学意义（P＜0.05）.结论 对于慢性跖趾关节不稳,跖板解剖修复结合Weil截骨可有效地矫正畸形,缓解临床症状,改善患足功能,近期临床疗效令人满意.

Objective To evaluate the clinical outcome of plantar plate repair with Weil osteotomy for chronic instability of the lesser metatarsophalangeal joint.Methods From February 2012 to January 2013,19 patient with chronic instability of the lesser metatarsophalangeal joint were treated in our department.They were 18 females and one male with an average age o f 57 years （from 51 to 65 years）.By the Coughlin＇s classification,3 cases were grade 1,5 cases grade 2,9 cases grade 3 and 2 cases grade 4.Except for one case involving both the second and the third metatarsophalangeal joints,all lesions were located at the second metatarsophalangeal joint.Weil osteotomy was used to shorten and elevate the affected metatarsal head.Injury to the plantar plate was detected before directly repaired in 17 cases and with transfer of the flexor digitorum longus in 2 cases.American Orthopaedic Foot and Ankle Society （AOFAS） and visual analogue scale （VAS） scores were used to assess the clinical outcome.Results The 2 patients who underwent tendon transfer were excluded from the final analysis.The mean follow-up period was 18 months （from 12 to 24 months）.The symptoms were alleviated in all the patients.The dislocated metatarsophalangeal joints were reduced,and postoperative Lachman tests were negative.Radiological exams showed corrected alignment of the lesser metatarsophalangeal joint.At the last follow-up,the AOFAS score （83.4 ± 8.7） and VAS score （1.3 ± 0.9） were significantly improved compared to the preoperative ones （40.7 ± 6.9 and 6.8 ± 1.2,respectively） （P 〈 0.05）.Conclusions For chronic instability of the lesser matatarsophalangeal joint,anatomical plantar plate repair with Weil osteotomy can restore the alignment of the metatarsophalangeal joint,diminish the pain and improve the functional recovery.Its short term clinical outcome is promising.