摘要目的 探讨基于迷你单臂外架的手风琴技术治疗先天性跖骨短小症的临床疗效。方法 回顾性分析2009-01至2019-05解放军总医院第一医学中心骨科由同一高职医师治疗的25个短小跖骨症,年龄18~34岁,平均24岁。均采用迷你单臂外架固定,通过手风琴技术延长跖骨,术后跖趾关节早期全程锻炼,末次随访进行功能评价。结果 所有患者均完成治疗和随访,随访时间9~56个月,平均24个月。跖骨延长区均获得愈合,平均延长长度15 mm, 愈合指数为61.8 d/cm;术后跖趾关节活动范围轻度减小(90.5° vs. 85.0°, t=1.983,P=0.061),功能评分得到提升(82.5 vs. 92.1, t=-5.892,P<0.001);2个跖骨发生钉道感染,并发症发生率8%,未发现骨折等严重并发症。结论 手风琴技术可改善新生跖骨质量,避免了跖趾关节僵硬,术后功能良好,并发症少,是治疗跖骨短小症的较好选择。
Abstract：Objective To explore the clinical effects of accordion technique based on mini monolateral external fixator in the treatment of congenital brachymetatarsia. Methods Retrospective analysis of 25 patients with brachymetatarsia treated by a same surgeon from Jan 2009 to May 2019, with a mean age of 24 years(from 18 to 34 years) was conducted. All patients were fixed with a monolateral external fixator and the metatarsal was lengthened by accordion technique. Postoperative early full range exercise of metatarsophalangeal joints was conducted to avoid joint stiffness And the functional evaluation was performed at the last follow-up. Results Surgery and the follow-up were completed for all patients. Follow-up ranged from 9 to 56 months with an average of 24 months. The length area of metatarsal was healed without complications. The mean length of distraction was 15 mm and the healing index was 61.8 day/cm. The postoperative metatarsophalangeal joint had a smaller range of motion than the preoperative (90.5° vs. 85.0°, t=1.983,P=0.061) but the functional scores were better than preoperative (82.5 vs. 92.1, t=-5.892,P<0.001). Nail infection occurred in 2 metatarsal bones and the complication rate was 8% without serious complications such as fractures. Conclusions Accordion technique is a reliable option in treating brachymetatarsia because of its good osteogenesis quality, less stiffness of metatarsophalangeal joint, good postoperative function and less complications.
Neretin A S, Menshchikova T I. Value of ultrasonography and radiography for the study of bone regeneration in lengthening of the fourth ray in brachymetatarsia[J]. Foot Ankle Surg, 2021,27(4):432-438.
[2]
Ray J, Andrews N A, Dib A, et al. Management of acute lesser toe pain[J]. Postgrad Med, 2021,133(3):320-329.
[3]
Geddens R, Dembowski S C. Brachymetatarsia as a source of pain in a us military trainee[J]. J Orthop Sports Phys Ther, 2018, 48(11):904.
[4]
Chaparro F, Espinoza R, Pellegrini M J, et al. One-stage lengthening and minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for brachymetatarsia[J]. Foot Ankle Int, 2021,24:10711007211039526.
[5]
Klauser H O. The surgical treatment of brachymetatarsia[J]. Foot Ankle Clin, 2021,26(4):685-704.
[6]
Fuiano M, Mosca M, Caravelli S, et al. Callus distraction with external fixator for the treatment of congenital brachymetatarsia of the fourth ray[J]. Foot Ankle Surg, 2020,26(6):693-698.
[7]
Kim H S, Lee Y S, Jung J H, et al.Complications of distraction osteogenesis in brachymetatarsia: Comparison between the first and fourth brachymetatarsia[J]. Foot Ankle Surg, 2019,25(2):113-118.
[8]
Lamm B M, Moore K R, Knight J M, et al. Intramedullary Metatarsal Fixation for Treatment of Delayed Regenerate Bone in Lengthening of Brachymetatarsia[J]. J Foot Ankle Surg, 2018,57(5):987-994.
[9]
Zhang Q, Zhang W, Zhang Z,et al. Accordion technique combined with minimally invasive percutaneous decortication for the treatment of bone non-union[J]. Injury, 2017,48(10):2270-2275.
[10]
Barik S, Farr S. Brachymetacarpia and brachymetatarsia: do we need to operate? [J]. EFORT Open Rev, 2021,6(1):15-23.
Kim H T, Hong S M, Kim I H. Treatment of brachymetatarsia involving the great toe[J].JB JS Open Access, 2018,3:e0046.
[13]
Mann M, Hulsemann W, Winkler F, et al.Distraction osteogenesis is an effective method to lengthen digits in congenital malformations[J]. Handchir Mikrochir Plast, 2016,48(1): 48-52.
[14]
Toh S, Narita S, Arai K,et al.Distraction lengthening by callotasis in the hand[J]. J Bone Joint Surg Br, 2002,84(2): 205-210.
Fusini F, Alessandro M, Rava A, et al.Aetiology, diagnosis, and treatment of brachymetatarsia: a narrative review[J]. Musculoskelet Surg, 2021,7:15.
[18]
Lee K B, Park H W, Chung J Y,et al.Comparison of the outcomes of distraction osteogenesis for first and fourth brachymetatarsia[J]. J Bone Joint Surg Am, 2010,92(16): 2709-2718.
2022, Vol. 33 
