Ilizarov技术治疗先天性第四跖骨短小症:延长比例亚组分析  

Ilizarov technique for treatment of congenital brachymetatarsia of the fourth:subgroup analysis of prolongation ratio

作　　者：梁家畅 管华[1] 冯恩辉 陈谱 黄伟明[1] 何剑波[1] 谢杰伟[1] Liang Jiachang;Guan Hua;Feng Enhui;Chen Pu;Huang Weiming;He Jianbo;Xie Jiewei(Department of Foot and Ankle Trauma,Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120,Guangdong Province,China)

机构地区：[1]广东省中医院创伤足踝科,广东省广州市510120

出　　处：《中国组织工程研究》2025年第33期7217-7222,共6页Chinese Journal of Tissue Engineering Research

基　　金：广东省中医院科学院技术研究拔尖人才专项项目(BJ2022YL13),项目负责人:谢杰伟;广东省软科学研究计划项目(2020A1414040031),项目负责人:谢杰伟。

摘　　要：背景:Ilizarov技术治疗先天性第四跖骨短小症十分有效,但仍有并发症,目前对于第四跖骨延长最佳比例仍存在争议。目的:探讨Ilizarov技术治疗先天性第四跖骨短小症的临床疗效及最佳延长比例。方法:收集2021年8月至2023年10月在广东省中医院使用Ilizarov技术治疗先天性第四跖骨短小症患者的病历资料,评估患者治疗前后美国矫形外科足踝协会评分、第四跖骨手术前后长度、术后并发症等情况;并对延长长度比例进行亚组分析,评估术式的最佳适用条件。结果与结论:①共纳入16例患者,患者治疗前第四跖骨长度为(43.51±3.75)mm,短缩长度为(12.53±2.82)mm,治疗期间延长时间为(36.95±4.12)d,带外固定支架时间为(102.30±32.74)d,治疗后延长长度为(13.90±3.47)mm,延长比例为(32.30±9.10)%;②末次随访美国矫形外科足踝协会评分显著高于治疗前(t=0.763,P<0.01);③主要术后并发症有骨不连、跖趾关节脱位、跖趾关节僵硬、第四跖骨延长过度,所有患者无感染、趾端感觉异常;④基于延长长度比例亚组分析显示,延长长度比例≤35.36%组患者并发症发生率(17%)明显低于延长长度>35.36%组(100%)(t=14.008,P<0.01);同时延长长度比例≤35.36%组患者术后美国矫形外科足踝协会评分(90.25±3.01)分高于延长长度比例>35.36%组(82.00±9.97)分(t=2.254,P=0.037);⑤提示Ilizarov技术治疗先天性第四跖骨短小症手术创伤小,可显著改善患者足部畸形,尤其适用于治疗延长长度比例不超过35.36%的患者,并发症发生率低,效果满意。BACKGROUND:The Ilizarov technique is very effective in the treatment of congenital brachymetatarsia of the fourth,but there are still some complications.The optimal proportion of lengthening of the fourth metatarsal is still controversial.OBJECTIVE:To explore the clinical efficacy of Ilizarov technique in the treatment of congenital brachymetatarsia of the fourth and the optimal lengthening ratio.METHODS:Medical records of patients with congenital brachymetatarsia of the fourth treated with Ilizarov technique in Guangdong Provincial Hospital of Traditional Chinese Medicine from August 2021 to October 2023 were collected.American Orthopaedic Foot and Ankle Society scores before and after the treatment,length of the fourth metatarsal before and after surgery,and postoperative complications were evaluated.The prolongation ratio was analyzed by subgroups to assess the best suitable length for the operative conditions.RESULTS AND CONCLUSION:(1)A total of 16 patients were included.The length of the fourth metatarsal before treatment was(43.51±3.75)mm,and the shortening length was(12.53±2.82)mm;the lengthening time during the treatment period was(36.95±4.12)days,and the time with external fixation bracket was(102.30±32.74)days,and the lengthening length after the treatment was(13.90±3.47)mm,and the prolongation ratio was(32.30±9.10)%.(2)American Orthopaedic Foot and Ankle Society scores were significantly increased at the last follow-up compared with that before treatment(t=0.763,P<0.01).(3)The main postoperative complications were bone nonunion,metatarsophalangeal joint dislocation,metatarsophalangeal joint narrowing,and excessive lengthening of the fourth metatarsal.All patients were free of infection and abnormal sensation in the toe.(4)Subgroup analysis based on prolongation ratio showed that the rate of complications in patients in the prolongation ratio≤35.36%group(17%)was significantly lower than the prolongation ratio>35.36%group(100%)(t=14.008,P<0.01).Meanwhile,the postoperative American Orthopaedic Foo

关 键 词：ILIZAROV技术 第四跖骨短小症 跖骨延长 延长比例 并发症 骨科植入物 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683.42