康庆林;陆联松;喻鑫罡;程栋;吴旭华;曾炳芳;

• 1:上海市第六人民医院骨科

摘要(Abstract)：

[目的]探讨牵张成骨术治疗先天性第四跖骨短小症的效果,并介绍跖侧入路截骨的优点。[方法]2008年6月～2010年3月,共治疗先天性第四跖骨短小症15例。均为女性;年龄18～34岁,平均23.5岁。15例病人共有22根跖骨短小,其中8例为单侧第4跖骨短小,5例为双侧第4跖骨短小,2例为单侧同足有第1和第4跖骨短小。跖骨短缩1.5～2.5 cm,平均2 cm。在影像增强器的帮助下,采用足背侧安装Orthofix单边延长支架,跖侧入路截骨。随访时间8～24个月,平均12个月。所有跖骨都延长到满意的长度,延长骨痂完全钙化。[结果]延长长度12～24 mm,平均18 mm,延长百分比25.8%～48.7%,平均32.6%。骨延长指数(延长1 cm需要的时间)为52 d/cm～85.8 d/cm,平均63.5 d/cm。按照美国足踝矫形外科协会(the american orthopedic foot and ankle society,AOFAS)的功能评判标准,平均AOFAS评分为89.6分,10例优,3例良,2例可。每个足趾延长后足背遗留直径1 mm点状瘢痕4个,足底切口为线性瘢痕,长2 cm,对功能无任何影响。全部患者对延长的结果和足外观满意。并发症包括:延长跖骨成角4例,对延长足外观无影响;跖趾关节间隙缩窄13例,活动度减小,这是影响AOFAS评分的主要因素,随时间延长而明显改善。[结论]跖侧入路截骨延长治疗先天性第四跖骨短小症能使短小的跖骨恢复到满意的长度,遗留足背瘢痕小,对应的足趾功能恢复好,是一种值得推荐的好方法。

关键词(KeyWords)： 先天性跖骨短小症;外固定器;骨痂延长;并发症

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 康庆林;陆联松;喻鑫罡;程栋;吴旭华;曾炳芳;

Email:

DOI:

参考文献(References)：

• [1]Lamm BM.Percutaneous distraction osteogenesis for treatment ofbrachymetatarsia[J].J Foot Ankle Surg,2010,2:197-204.
• [2]Giannini S,Faldini C,Pagkrati S,et al.One-stage metatarsallengthening by allograft interposition:a novel approach for congenitalbrachymetatarsia[J].Clin Orthop,2010,7:1933-1942.
• [3]Lee WC,Yoo JH,Moon JS.Lengthening of fourth brachymetatarsia bythree different surgical techniques[J].J Bone Joint Surg Br,2009,11:1472-1477.
• [4]Lee WC,Suh JS,Moon JS,et al.Treatment of brachymetatarsia of thefirst and fourth ray in adults[J].Foot Ankle Int,2009,10:981-985.
• [5]Wilusz PM,Van P,Pupp GR.Complications associated with distrac-tion osteogenesis for the correction of brachymetatarsia:a review offive procedures[J].J Am Podiatr Med Assoc,2007,3:189-194.
• [6]Shim JS,Park SJ.Treatment of brachymetatarsia by distraction osteo-genesis[J].J Pediatr Orthop,2006,2:250-254.
• [7]Yamada N,Yasuda Y,Hashimoto N,et al.Use of internal callus dis-traction in the treatment of congenital brachymetatarsia[J].Br J PlastSurg,2005,7:1014-1019.
• [8]Kim JS,Baek GH,Chung MS,et al.Multiple congenital brachymeta-tarsia.A one-stage combined shortening and lengthening procedurewithout iliac bone graft[J].J Bone Joint Surg Br,2004,7:1013-1015.
• [9]Schimizzi A,Brage M.Brachymetatarsia[J].Foot Ankle Clin,2004,3:555-570.
• [10]Wada A,Bensahel H,Takamura K,et al.Metatarsal lengthening bycallus distraction for brachymetatarsia[J].J Pediatr Orthop B,2004,3:206-210.
• [11]Song HR,Oh CW,Kyung HS,et al.Fourth brachymetatarsia treatedwith distraction osteogenesis[J].Foot Ankle Int,2003,9:706-711.
• [12]Kim HT,Lee SH,Yoo CI,et al.The management of brachymetatarsia[J].J Bone Joint Surg Br,2003,5:683-690.
• [13]Houshian S,Skov O,Weeth RE.Correction of congenital brachymeta-tarsia by gradual callus distraction[J].Scand J Plast Reconstr SurgHand Surg,2002,6:373-375.