Weil截骨术治疗原发性跖痛症的短期临床效果评价

Short-term clinical curative effect of Weil osteotomy in the treatment of primary metatarsalgia

目的 观察Weil截骨术治疗原发性跖痛症的短期临床效果。方法 自2011-04—2013-05采用Weil截骨术治疗原发性跖痛症39例（48个跖骨头）,切开、松解跖趾关节囊,避免损伤关节软骨,并将近节趾骨完全跖屈,彻底显露跖骨头,用摆锯自跖骨头关节面背侧下方2 mm沿足底负重平面向近端跖侧截骨,将远端跖骨块向近端平行推移,用直径1.5 mm克氏针由跖骨近端向跖骨头临时固定,用1枚直径1.7 mm皮质骨钉最终固定。比较术前及术后3个月跖骨绝对长度、跖趾关节活动度、VAS评分、AOFAS评分。结果 本组均获得随访7-24个月,平均15.2个月。截骨后跖骨平均缩短3.88 mm。所有患者术后无切口感染及截骨延迟愈合,跖侧疼痛均明显改善。关节间隙维持,患足外观正常,无转移性跖骨下疼痛。所有患者术后跖骨绝对长度缩短、跖趾关节活动度减小,但VAS评分明显降低、AOFAS评分明显升高,差异均有统计学意义（P〈0.05）。结论 Weil截骨术治疗原发性跖痛症短期临床疗效显著,是一种可靠的术式。长期疗效有待进一步观察。

Objective To observe the results of Weil osteotomy in the treatment of primary metatarsalgia. Methods From April 2011 to May 2013, Weil osteotomy was performed on 39 patients with primary metatarsalgia（48 metatarsal heads）. The metatarsophalangeal joint capsule was released, with plantar flexed of the proximal phalanx to expose the metatarsal head without damage the articular cartilage. Metatarsal bone was cut from 2 mm below dorsal side of the metatarsophalangeal joint along the foot bearing plane to proximate planta, the distal metatarsal wasblocked to the proximal end parallel and fixed from the proximal to the metatarsal head with a 1.5 mm Kirschner wire temporarily, fixed finally with a 1.7 mm one. The absolute length of metatarsal, metatarsophalangeal joint activity, VAS score and AOFAS score were compared before and 3 months after operation. Results All the patient were followed up for an average of 15.2 months（7 to 24 months）. The metatarsal bones were reduced by an average of 3.88 mm. All cases had no wound infection and delayed healing of the osteotomy and the pain of the plantar side was significantly improved. Joint space was maintained, appearance was normal, without metastatic metatarsal pain. Absolute length of metatarsal was shortened and metatarsophalangeal joint activity was decreased postoperative in all patients, but VAS score was decreased, AOFAS score was increased significantly（P〈0.05）. Conclusion Weil osteotomy has satisfied results in metatarsalgia, and it＇s effective to improve range of motion and relieve pain of joint.