第1跖骨远端斜行截骨术治疗僵硬的回顾分析

Clinical and radiological outcomes after distal oblique osteotomy for hallux rigidus

背景:僵硬是第1跖趾关节常见的退行性病变,主要表现为疼痛、背伸活动受限。僵硬的治疗常采用关节唇切除术与趾骨截骨术,但是对于第一跖骨是否存在抬高,跖骨截骨下沉和短缩是否可有效治疗僵硬,现有研究尚未得出一致结论。目的:分析僵硬患者是否存在第1跖骨抬高和过长,评价行第1跖骨远端斜行截骨术治疗僵硬的临床应用效果。方法:2015年1月至2016年5月行第1跖骨远端斜行截骨术治疗僵硬13例15足。记录术前侧位第1、2跖骨间夹角(IMA)、术后骨愈合时间以及并发症发生情况。比较术前及末次随访时的患者第1跖趾关节背伸活动度、美国足踝外科协会(AOFAS)趾功能评分、视觉模拟评分(VAS)、第1跖趾关节间隙、第1跖骨突出度(MPD)。结果:术前X线片示4足存在跖骨抬高(侧位IMA为4.8°~8.7°),8足存在第1跖骨过长(MPD为2.2~6.9 mm)。术后全部获得随访,随访时间为10~26个月,平均(16.7±4.7)个月。术后4周均达到骨愈合。第1跖趾关节背伸活动度由术前平均19.7°±10.4°(4°~40°)增加至末次随访时的平均57.9°±12.2°(36°~72°)。至末次随访时,AOFAS趾功能评分、VAS评分,以及相关影像学资料的第1跖趾关节间隙、MPD,均较术前有明显改善(P<0.001);随访期间,患者均无需进一步手术治疗,无转移性跖骨痛等并发症出现。结论:僵硬患者存在第1跖骨过长与上抬,第1跖骨远端斜行截骨术可有效治疗僵硬,明显改善跖趾关节功能,手术操作简单可靠,术后并发症较少。

Background： Hallux rigidus is a common problem of the first metatasophalangeal joint, defined as a condition characterized by pain and decrease of the range of motion, especially in dorsiflexion. Cheilectomy and osteotomy of the proximal phalanx were commonly used. It has been reported on the correction of the metatarsus primus elevates by metatar- sal osteotomies, but there remains no general consensus about the effect. Objective： To analyze the role of metatarsus pri- mus elevatus and excessive length in hallux rigidus, and evaluate the outcomes of the distal oblique osteotomy. Methods： To- tally 13 patients （15 feet） with hallux rigidus who received distal oblique osteotomy in our hospital from January 2015 to May 2016 were recruited. The overall clinical evaluations included dorsiflexion of the first MTPJ, the American Orthopae- dic Foot ＆ Ankle Society （AOFAS） scores, visual analogue scale （VAS） score, the first MTPJ space width, metatarsal pro- trusion distance （MPD）, intermetatarsal angle （IMA）, healing time and complications. Results： Preoperative radiography showed 4 feet with metatarsus primus elevates （IMA 4.8°-8.7°） and 8 feet with metatarsus excessive length （MPD： 2.2-6.9 nun）. The mean follow-up period was （16.7±4.7） months （range, 10-26 months） in all the patients. The bony union was achieved at 4 weeks postoperatively. Mean dorsiflexion of the first MTPJ increased from 19.7°±10.4° （4°-40°） preoperative- ly to 57.9°±12.2° （36°-72°） at the final follow-up. All the radiographic parameters and AOFAS score significantly improved at the final follow-up （P〈0.001）. There was no subsequent fusion or transfering metatarsalgia. Conclusions： These results confirm the metatarsus primus elevatus and excessive length in hallux rigidus, and the first metatarsal distal oblique osteoto- my is an effective surgical treatment for hallux rigidus as it restores joint motion with less complications.