拇趾外翻截骨术后第1跖骨的长度与转移性跖骨痛的相关性分析  

Correlative study between length of first metatarsal and transfer metatarsalgia after osteotomy of first metatarsal

作　　者：张奉琪[1] 裴宝岩[2] 魏书田[1] 赵海涛[1] 李智勇[1] 高建国[1] 张英泽[1] 

机构地区：[1]河北医科大学第三医院足踝外科,石家庄050051 [2]秦皇岛市第一医院骨科

出　　处：《中华医学杂志》2013年第43期3441-3444,共4页National Medical Journal of China

摘　　要：目的 评估第1跖骨头颈部截骨术后的跖骨长度、外翻角、第1～2跖间角、足底外形以及籽骨的位置与第2～5跖骨转移性疼痛的相关性.方法 回顾性分析2004年5月至2007年12月河北医科大学第三医院足踝外科375例（626足）拇趾外翻患者采用微创跖骨头颈斜截骨治疗的临床资料.手术前后均摄双足负重正侧位X线片,测量拇外翻角、跖间角及第1跖骨长度.应用F-Scan 足底应力步态分析仪测量手术前后足底应力分布情况.结果 随访时限为12～30个月,平均（18.5±6.8）个月.术后骨愈合满意,无延迟愈合及不愈合情况,皮肤感染1例1足,缝线反应1例1足.术后患者的拇趾外翻角为（7.2±4.6）°,第1、2跖骨间夹角为（5.1±1.7）°,平均矫正30.5 °和12.3 °.第1跖骨短缩0～2 mm 424足,4例出现了转移性跖骨头疼痛;第1跖骨短缩2～4 mm 186足,5例出现了第二跖骨头下转移性疼痛,足底负重区外移;第1跖骨短缩4～6 mm 16足,4例出现了第2、3跖骨头转移性疼痛,足底负重区明显外移;平均短缩（1.8±0.5）mm.第2、3转移性跖骨头痛与第1跖骨的长度呈负相关.第2～5跖骨痛与外翻角、跖间角的减小未发现联系.外翻角的减小与患者对外形满意度呈正相关.跖骨延长和第1～2跖骨间角减小无相关性.结论 维持第1跖骨的长度有助预防第2、3转移性跖骨痛,第一跖骨短缩以不超过2 mm为最佳.Objective To evaluate the correlation between the length of first metatarsal, hallux valgus angle （HVA）, intermetatarsal 1- 2 angle （IMA1-2）, plantar appearance, sesamoid position and postoperative 2 -5 transfer metatarsalgia. Methods Retrospective analysis was performed for the clinical data of 375 eases （626 feet） undergoing osteotomy of first metatarsal with mini-incision. All cases were examined radiographieally via weight-bearing and lateral views. HVA, IMA1-2 and the length of first metatarsal were measured preoperatively and postoperatively. Forefoot plantar pressure was measured during walking by Footscan system preoperatively and postoperatively. Results After a mean follow-up period of 12- 30 （18.5 ± 6. 8 ） months, all patients had satisfactory bone healing without late healing or disunion. There were superficial wound infection （ n = 1, 1 foot） and suture reaction （ n = 1, 1 foot ）. HVA was 7.18° ±4. 55° postoperatively and corrected by 30. 54° ; IMA1-2 5.07° ± 1.70° and corrected by 12. 33°. The number of shorting of first metatarsal during 0 - 2 mm was 424 feet, there was 1 case of transfer metatarsalgia at rays 4; the number during 2 -4 mm was 186 feet, there were 5 cases of transfer metatarsalgia at rays 2. The center of pressure shifted laterally; the number during 2 -4 mm was 16 feet, there were 4 eases of transfer metatarsalgia at rays 2 and 3. The center of pressure shifted evidently medially ; the shorting of first metatarsal was 4. 8 ± 0.46 mm. A negative correlation was found between length of metatarsal and transfer metatarsalgia at rays 2 and 3. No correlation existed between transfer metatarsalgia at rays 2 and 5, HVA and IMA1-2. A positive correlation existed between HVA decrease and patient satisfaction with their postoperative foot alignment. There was no correlation between lengthening of metatarsal and IMA1-2 decrease. Conclusion Length preservation of first metatarsal seems to prevent the postoperative transfer metatarsalgia on second and third rays

关 键 词：跖趾关节 足畸形 跖骨 拇趾外翻 

分 类 号：R687.3[医药卫生—骨科学]