- 期刊
Oblique Sliding Metatarsal Osteotomy for Pressure Metatarsalgia
蹠骨斜切術治療壓迫性蹠胝瘢痛
摘要
足部的足弓是由蹠骨形成，而五個蹠骨頭在正常情況是排列在同一水平面來共同承受前足部的負荷。若是蹠骨頭的排列不整，將使局部蹠胝負荷增加，而產生疼痛的胼胝。所以，治療這種壓迫性的疼痛，必須針對其病態結構的原因，那就是蹠趾關節的過度背屈變形。本文報告使用改良的遠端蹠骨骨切術，治療二十二名患者的四十腳趾，追蹤平均21.2個月，其中十九名患者(86.4％)得到滿意的結果。而三個患者由於過早拔除固定鋼釘而導致較差的結果。改良的方法包括盡可能斜切 ，可得到較大的骨切斜滑矯正及骨的癒合；而骨髓內釘固定及早期著地活動在保持骨足縱軸，避免足部僵硬外，更可令骨切處斜滑至一適當位置，而避免過度矯正導致的病灶轉移。和其他的方法比較，改良後的蹠骨斜切術是一種侵犯性較小，保存原來的組織，手術簡單，術後容易照顧，而結果有效而穩定的方法。
關鍵字
無資料並列摘要
The transverse arch of the foot is formed by metatarsals which heads lie in a straight line to endure most of the loading of the forefoot. Malalignment of one or mor metatarsal heads will result in incresed loading and produce local tender plantar callosity. The treatment of pressure metatarsalgia must aim for it's pathomechanic cause, that is, huyper-extension of metatarsophalangeal joint. We have modified the distal metatarsal osteotomy to treat 40 toes in 22 cases. Follow up for an average of 21.3 months (ranging from 18months to 31 months) indicated 19 cases(86.4%) with satisfactory resluts. The 3 cases with unsatisfied results were all due to early removal of the pin. Maximum oblige sloping of the osteotomy makes the osteotomy slide more easily and ensures union. Intramedullary pinning and early weight bearing maintain the osteotomic alignment, prevent foot stiffness and allow the distal fragment telescopes to be adequately positioned to prevent over correction which leads to transfer lesion. Compared to other methods, modified metatarsal osteotomy is less invasevi, preserves natural structure, is easily performed and easy cared for which leads to effective and stable result.