第二趾跖板慢性撕裂损伤的手术修复  

SURGICAL REPAIR OF CHRONIC TEARS OF THE SECOND PLANTAR PLATE

作　　者：俞光荣[1] 郁耀平[1] 张鹏[1] 杨云峰[1] 李兵[1] 张明珠[1] 

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《中国修复重建外科杂志》2013年第12期1446-1449,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨第2趾跖板慢性撕裂损伤手术修复方法及近期疗效。方法 2012年6月-2013年6月,收治第2趾跖板慢性撕裂损伤14例。男4例,女10例;年龄51～82岁,平均65.9岁。左侧5例,右侧9例。病程5～9年,平均6.2年。单纯第2趾锤状趾1例;外翻合并第2趾爪形趾2例,外翻合并第2趾锤状趾11例。均合并第2跖趾关节不稳。改良Lachman试验及牵拉试验均呈阳性。作第2趾背侧切口首先纠正外翻后,行Weil截骨联合缝合修复跖板。结果 术后患者切口均Ⅰ期愈合。12例患者获随访,随访时间6～12个月,平均8.2个月。外翻及爪形趾、锤状趾畸形均获得矫正,术后3个月改良Lachman试验及牵拉试验均呈阴性。术后6个月2例第2跖趾关节出现轻度疼痛,足趾活动无僵硬感。末次随访时,按照美国足踝协会（AOFAS）的前中足评分标准为（90.50±3.73）分,明显高于术前的（57.33±4.99）分,差异有统计学意义（t=21.724,P=0.000）。结论 跖板是维持跖趾关节稳定的关键结构,手术缝合修复第2趾跖板慢性撕裂损伤可获得较好近期疗效。Objective To explore the operative methods and the short-term effectiveness to repair chronic tears of the 2nd plantar plate. Methods Between June 2012 and June 2013, 14 patients with chronic tears of the 2nd plantar plate were treated. There were 4 males and 10 females with an average age of 65.9 years （range, 51-82 years） and with an average disease duration of 6.2 years （range, 5-9 years）. The left side was involved in 5 cases and the right side in 9 cases. One patient had simple hammer toe; 2 patients had hallux valgus and claw toe; and 11 patients had hallux valgus and hammer toes. All of them had unstable the 2nd metatarsophalangeal joints. The results of modified Lachman test and drawer test were positive. The surgical treatment included a Well osteotomy and plantar plate repair operation for rupture via dorsal incision after correcting hallux valgus. Results Primary healing of incision was obtained in all patients. Twelve patients were followed up 6-12 months （mean, 8.2 months）. Hallux valgus, claw toe, and hammer toe were all corrected. The results of modified Lachman test and drawer test were negative at 5 months after operation. Mild pain of the 2nd metatarsophalangeal joint occurred, but no stiff was observed in 2 cases at 6 months after operation. The midfoot and forefoot score of American Orthopedic Foot and Ankle Society （AOFAS） was 90.50 ± 3.73 at last follow-up, which was significantly higher （t=21.724, P=0.000） than preoperative score （57.33± 4.99）. Conclusion The plantar plate is the key to maintain the stability of the metatarsophalangeal joints, and surgical repair can achieve good short-term effectiveness in treating chronic tears of the 2nd plantar plate.

关 键 词：第2趾 跖板慢性撕裂损伤 跖趾关节 软组织修复 

分 类 号：R687[医药卫生—骨科学]