改良Weil截骨合并软组织平衡治疗第2趾锤状趾畸形的疗效分析

Outcome of modified Weil osteotomy combined with soft tissue balancing for the second hammer toe deformity

背景:第2趾锤状趾畸形的手术治疗众多,如何选择尚无定论。目的:探讨改良Weil截骨结合软组织平衡治疗第2趾锤状趾畸形的疗效,以及不同手术方式的优缺点。方法:回顾性分析2010年1月至2015年12月手术治疗的91例第2趾锤状趾畸形患者的临床资料,男19例,女72例;年龄42~82岁,平均(57.3±3.4)岁。均为单侧手术,左足50例,右足41例;改良Weil截骨24例,改良Weil截骨+趾长伸肌腱延长24例,改良Weil截骨+趾长伸肌腱延长+近节趾间关节融合12例,改良Weil截骨+近节趾间关节融合+屈肌腱移位21例,改良Weil截骨+趾长伸肌腱延长+跖板修复10例。记录手术方式、手术前后影像学资料、手术前后AOFAS前足评分、并发症情况。结果:91例患者全部获得随访,随访时间为13~27个月,平均(21.4±2.7)个月。AOFAS前足评分,术前平均(48.6±8.5)分,术后平均(85.0±10.6)分。术后并发症:漂浮趾6例,跖趾关节半脱位10例,跖趾关节僵硬4例,复发3例,未见足趾坏死。结论:第2趾锤状趾畸形是前足常见的足趾畸形,病因复杂。改良Weil截骨合并软组织平衡可以有效解决该畸形存在的矢状面与横断面不稳定,但是畸形复发、漂浮趾畸形、跖趾关节半脱位仍是常见的术后并发症。

Background： There is still no conclusion on how to choose an appropriate surgery from various options for the second hammer toe deformity. Objective： To explore curative effect of modified Weil osteotomy in combination with soft tissue balancing for the second hammer toe deformity. Methods： A total of 91 patients underwent surgical correction for the second hammer toe from January 2010 to December 2015 were included in this retrospective study. There were 19 males and 72 females with an average age of（57.3±3.4） years（range, 42-82 years）. The deformity located in 50 left feet and 41 right feet. There were 24 cases of modified Weil osteotomies, 24 cases of modified Weil osteotomies combined with extensor digital longus lengthening, 12 cases of modified Weil osteotomies combined with extensor digital longus lengthening and interphalangeal joint fusion, 21 cases of modified Weil osteotomies combined with interphalangeal joint fusion and flexor tendon transfer, and 10 cases of modified Weil osteotomies combined with extensor digital longus lengthening and plantar plate repair. Surgical methods, preoperative and postoperative imaging data and AOFAS forefoot score, and complications were recorded. Results： The mean duration of follow-up was（21.4±2.7） months（range 13-27 months） in all the patients. The AOFAS forefoot score was 48.6±8.5 and 85.0±10.6 before and after surgery, respectively. Float toe occurred in 6 patients, subluxation of metatarsophalangeal joint in 10 patients, metatarsophalangeal joint rigidus in 4 patients and recurrence in 3 patients. No digital necrosis was found. Conclusions： The second hammer toe is a common deformity of forefoot with complex etiology. Modified Weil osteotomy in combination with soft tissue balancing is able to effectively correct the sagittal and axial instability, but deformity recurrence, float toe and metatarsophalangeal joint subluxation are common postoperative complications.