伴重复跖骨的足部中央型多趾的手术治疗与疗效分析

Surgical Management and Outcomes of Central Polydactyly with Duplicated Metatarsals of the Foot

目的探讨伴重复跖骨的足部中央型多趾的手术治疗及其疗效.方法2013年2月至2018年10月,5例伴重复跖骨的中央型多趾患者行手术治疗.设计"V"形切口,切除多趾序列,修复骨间肌、跖骨间韧带等,部分患者行楔骨的楔状截骨.比较术前、术后的跖骨间距比例(Metatarsalgapratio,MGR)来定量足宽改变;采用美国足踝外科协会(AOFAS)评分体系来评价足功能.结果本组患者切口均一期愈合,随访结果显示患者行走功能正常,术后MGR与术前相比均明显减小,AOFAS量表评分88~100分,表明术后足功能优良.结论伴重复跖骨的中央型多趾手术治疗效果确切,术后足功能优良;若足背较宽,术中需行楔骨的楔状截骨以尽可能减小足宽.

Objective To explore the surgical management and outcomes of central polydactyly with duplicated metatarsals. Methods Five child patients of central polydactyly with duplicated metatarsals were retrospectively reviewed from February 2013 to October 2018. They were treated with the V-shape incision, followed by polydactyly excision, repairs of the interosseus and the intermetatarsal ligaments, as well as wedge resection of cuneiforms in wide-forefoot cases. For follow-up assessment, the metatarsal gap ratio (MGR) values were measured and compared. The American Orthopaedic Foot and Ankle Society (AOFAS) rating systems were adopted to evaluate the foot function. Results All cases recovered well. None have reported any difficulties in walking or running. Postoperative MGR values decreased significantly compared with preoperative. The results of AOFAS scales were from 88 to 100 points, indicating excellent/good foot function. Conclusion Surgical treatments of central polydactyly with duplicated metatarsals successfully change the cosmetic appearance of the foot, while retain the satisfactory foot function. To minimize the width of the forefoot, wedge resection of the cuneiforms is strongly recommended in wide-forefoot cases.