Weil截骨术

Weil截骨术通过对跖骨头、颈部位进行斜行截骨,以实现跖骨短缩。该术式由美国的Weil LS医师于1985年首先提出并将其应用于中央跖痛症(第2～4跖骨)患者,随后由Barouk医师在欧洲推广。与传统的截骨术相比,Weil截骨术具有操作简单、截骨部位接触面积大、断端固定可靠等优点,因此在前足疾患的矫形手术中应用日趋广泛。     

两种不同术式治疗跖痛症临床疗效分析

[目的]探讨微创截骨与Weil截骨两种不同术式治疗跖痛症的适应证及临床疗效。[方法]对51例(64足/104跖骨)轻度跖痛症患者分别行跖骨颈部微创截骨抬高术(A组,24例/26足/55跖骨)和Weil截骨术(B组,27例/38足/49跖骨)。比较两组患者手术前后责任跖骨的VAS评分、ACFAS评分及跖骨头下最大压力、最大压强及冲量变化,评价两组病例的临床疗效。[结果]术后随访时间6~36个月,平均20个月。A、B两组病例手术前后VAS评分和ACFAS评分差异有统计学意义(P0.05);Footscan足底压力测试手术前后责任跖骨头下最大压力、最大压强及冲量差异均有统计学意义(P0.05)。A、B两组病例术后VAS评分、ACFAS及足底压力测试数据比较,差异无统计学意义(P0.05)。A组出现截骨延迟愈合4例(4跖骨)。[结论]两种截骨术均能有效缓解跖痛症的疼痛症状。微创截骨抬高术治疗跖痛症,疗效确定,易于掌握,并发症少,适合于临床推广应用。     

跖痛症治疗新进展

任何解剖结构异常、足踝部疾病或畸形及医源性因素都可引起跖痛症.跖痛症治疗方法较多,对早期症状尚轻、功能尚可的病人可先行矫形鞋、药物及理疗等保守治疗,病情持续加重或保守治疗无效则采用手术治疗.目前报道有多种手术治疗方法,如跖骨远端斜形截骨术(Weil截骨术)、跖骨干截骨术、跖侧髁部切除术及跖骨头切除术等,其中Weil截骨术可将前足应力均衡再分布,能有效改善症状及功能,已在临床上广泛应用.该文就跖痛症生物力学分析、分型、诊断及治疗方法等作一综述.     

Weil截骨治疗(足母)外翻转移性跖痛

[目的]回顾分析Weil截骨治疗(踇)外翻转移性跖痛的疗效.[方法]自2004年至200:5年联合应用第1跖骨基截骨及Weil截骨治疗伴有外侧跖骨头转移性跖痛的中重度外翻17例25足.患足手术前后常规拍摄足正侧位片,测量足母外翻角(HVA),I-Il跖骨间角(IMA),使用美国足踝外科协会(踇)趾-跖趾-趾间关节评分系统(AOFAS)评分评估临床疗效.手术方法根据患者术前症状选择第1跖骨基底截骨联合外侧跖骨头Weil截骨.[结果]患者(踇)外翻角(HVA)术前为32°±5.7°,术后为12.8°±3.5°;Ⅰ-Ⅱ跖骨间角(IMA)术前为23.2°±3.7°,术后为10.5°±0.7°;AOFAS评分术前45.6±6.9分,术后86.9±4.6分;Weil截骨术后的跖骨短缩3-8 mm,平均4.5 mm;术后18足跖痛症状完全缓解,7例好转,所有患者日常生活正常,无需进一步治疗.[结论] (踇)母外翻术前应综合分析足部的生物力学变化,对伴有外侧转移性跖痛的严重(踇)外翻患者,联合使用第1跖骨基截骨和外侧跖骨头Weil截骨可获得良好疗效.     

跖骨近端短缩跖趾关节复位术治疗跖痛症合并重度跖趾关节脱位临床疗效分析

目的探讨跖骨近端短缩跖趾关节复位术治疗跖痛症合并重度跖趾关节脱位的临床疗效。方法采用跖骨近端截骨短缩、跖趾关节复位术治疗的跖痛症合并重度跖趾关节脱位65例,共83个跖趾关节,其中第2跖趾关节68个,第3跖趾关节15个。患足均于手术前后拍摄负重正侧位X线片,测量相关指标,并采用ACFAS、VAS评分对手术前后进行临床评估。结果截骨后跖骨平均短缩长度为5.94 mm。术后跖趾骨夹角、跖骨切线角、跖趾关节间隙及跖趾关节活动度等指标较术前均有改善,差异有统计学意义(P<0.05)。ACFAS评分术前为(44.06±7.54)分,术后为(90.43±3.88)分;VAS评分术前为(8.14±0.97)分,术后为(1.14±0.73)分;各评分术后均较术前明显改善,差异有统计学意义(P<0.05)。结论跖骨近端短缩跖趾关节复位术治疗跖痛症合并重度跖趾关节脱位临床疗效确切。     

改良Weil截骨手术治疗第2—5跖趾关节脱位的疗效评估

背景：Weil截骨术常用于治疗第2-5跖趾关节半脱位或脱位引起的跖痛症,但也经常出现并发症。目的：探讨改良Weil截骨术治疗第2-5跖趾关节脱位畸形的疗效。方法：2009年至2011年采用改良Weil截骨术治疗第2-5跖趾关节脱位畸形32足,行45趾截骨。男10足,女22足。患足手术前后常规拍摄足正侧位x线片,测量跖骨长度,使用美国足踝外科协会（AOFAS）跽趾-跖趾-趾间关节评分系统评估临床疗效。结果：Weil截骨术后跖趾关节畸形恢复正常关系43例,AOFAS评分术前（48．6±7．5）分,术后（85．9±6．5）分;跖骨截骨后短缩2～7mm,平均4．3mm。2例浮趾畸形,经保守治疗好转。2例复位后仍有半脱位。1例可折断钉过长疼痛。结论：改良Weil截骨能有效纠正第2-5跖趾关节脱位,临床疗效满意。     

可吸收钉内固定治疗跖痛症临床疗效分析

[目的]探讨可吸收钉内固定治疗跖痛症的临床疗效。[方法]2012年12月~2014年6月采用可吸收钉内固定治疗不同程度跖痛症患者41例52足,男11例12足,女30例40足;年龄47~76岁,平均60.98岁;共68个跖骨,其中采用Weil截骨可吸收钉内固定术者32个跖骨,采用跖骨近端短缩跖趾关节复位术者36个跖骨。随访时间6~18个月,平均12.5个月。患足均于手术前、后拍摄负重正侧位X线片,测量相关指标,测量记录术趾跖趾关节活动度,应用美国足踝医师学会前足评分系统(ACFAS)、视觉模拟量表(VAS)评分对治疗前后进行评估,采用Footscan足底压力分析仪测量步态周期中责任跖骨头下最大压力、最大压强及冲量的变化。[结果]Weil截骨可吸收钉内固定术后跖骨平均短缩长度为3.52 mm;术足跖趾关节间隙、跖趾骨夹角等X线指标与术前相比,差异无统计学意义(P0.05);VAS评分术前为(6.26±3.24)分,术后为(1.21±0.63)分,ACFAS评分术前为(62.56±10.42)分,术后为(91.96±9.21)分,差异均有统计学意义(P0.05)。跖骨近端短缩跖趾关节复位术后跖骨平均短缩长度为5.87 mm;术足跖趾关节间隙、跖趾骨夹角等X线指标与术前相比,差异均有统计学意义(P0.05);VAS评分术前为(8.56±3.41)分,术后为(1.92±0.51)分,ACFAS评分术前为(46.37±11.64)分,术后为(90.96±8.86)分,差异均有统计学意义(P0.05)。两种术式术后患者责任跖骨头下最大压力、最大压强及冲量与术前相比均具有统计学意义(P0.05),术后跖趾关节活动度较术前明显减小(P0.05)。术后出现术趾皮肤麻木11例,术趾皮肤坏死3例,经换药后痊愈。截骨端无移位,全部获得骨性愈合,未发现关节脱位复发、排异反应等并发症。[结论]可吸收钉用于跖痛症手术截骨端内固定,固定可靠,临床疗效确切。     

基于X线分度的跖痛症临床治疗方案研究

目的探讨并评价跖痛症依据X线分度制定的治疗方案的适应证及临床疗效。方法笔者自2013-10—2015-08根据跖痛症的分度标准确定手术方案,采用微创截骨跖骨头抬高术(A组)、Weil截骨术(B组)、跖骨近端截骨短缩内固定术(C组)、跖骨截骨短缩内固定加跖趾关节切开复位克氏针固定术(D组)4种术式治疗跖痛症49例(66足/120跖骨),手术前、后测量责任跖骨头下胼胝体大小、跖趾关节活动度、ACFAS评分、VAS评分以及步态周期中责任跖骨头下最大压力、最大压强及冲量的变化。结果所有患者均获随访12~24个月,平均14个月。4种术式术后责任跖骨头下胼胝痛消失或明显减轻者96.7%。4组手术前后VAS评分、ACFAS评分差异均有统计学意义(P0.05);A组手术前后跖趾关节活动度变化不明显,差异无统计学意义;其余3组关节活动度均较术前减小,差异均有统计学意义(P0.05)。Footscan足底压力测试手术前后相应跖骨头下最大压强、最大压力及冲量差异有统计学意义(P0.05)。术后出现转移性跖痛症7例(跖骨),占5.83%;有8例(跖骨)出现截骨端延迟愈合,占6.67%;无截骨不愈合。结论根据跖痛症分度标准确定的治疗方案,可显著减轻疼痛症状,疗效确切,有较好的临床指导意义。     

Comparative study of the Weil osteotomy with and without fixation

Background

Weil osteotomy is a technique widely used in patients with metatarsalgia which shortens the metatarsal and reduces the load under the metatarsal head.

Methods

The aim of this paper is to compare the results of the Weil osteotomy with and without any fixation system.We present a retrospective study of 92 patients (97 feet) who underwent treatment for metatarsalgia between 1999 and 2005. One hundred and six osteotomies were vixed using a screw amd no fixation was used in 92. The mean follow-up was 51.2 and 46.6 months respectively.

Results

All the patients were evaluated following the AOFAS LMIS scale, obtaining a mean score of 69.8 points (ranged 15–100) and 75.3 points (from 47 to 100) in each group (P = 0.11).

Conclusions

The results of fixed and unfixed Weil osteotomies were not significantly different. Our study could not find a significant relationship between metatarsal shortening and main complications (recurrent metatarsalgia, transfer metatarsalgia and stiffness of the metatarsophalangeal joint).     

The Weil osteotomy for the treatment of painful plantar keratoses

Management of painful plantar corns remains challenging. Failure of conservative treatment may necessitate surgical intervention. The aim of this study was to assess the effectiveness of the Weil osteotomy in the treatment of painful plantar corns. A total of 29 patients (33 feet) underwent Weil osteotomy combined with plantar lesion excision of a single metatarsal of either the second, third or fourth metatarsals. These were reviewed post-operatively at an average of 42.4 months. At final review, nine feet (27%) presented with a corn. Four feet (12%) developed transfer metatarsalgia with a total of seven feet (21%) requiring revision surgery. The average metatarsal shortening was 4.5 mm. Requirement for regular clinical lesion reduction fell from an average of 5.6 weeks to 12 weeks (P<0.001) between treatments and the American Orthopaedic Foot And Ankle Society clinical rating scale improved by an average of 48 points (P<0.001). The Weil osteotomy is a moderately effective intervention which should be considered in planning the treatment of intractable plantar corns.     

Weil osteotomy: Assessment of medium term results and predictive factors in recurrent metatarsalgia

Background

The angle of the Weil osteotomy is usually referenced relative to the floor irrespective of the plantar angulation of the metatarsal. This study aims to analyse the long term results following the Weil osteotomy and identify the cause of poor outcome.

Methods

This study presents a retrospective review of 61 patients (86 feet), with mean follow-up of 31 months. Each patient underwent clinical, pedobarographic and radiological examination. The radiographs obtained included ‘Metatarsal Skyline Views’ (MSV), to assess the plantar declination of the metatarsal heads following the osteotomy. The functional scoring was performed using AOFAS and Foot Function Index.

Results

Fifty-five patients (80 feet) showed good to excellent results clinically. Six patients had persistent metatarsalgia. All these 6 patients had callosities beneath metatarsal heads. Pedobarography showed peak pressures in the same distribution as callosities and the MSV showed increased plantar declination of the metatarsal heads. This correlation was found to be significant (p < 0.05).

Conclusion

The Weil osteotomy is a safe and effective treatment for metatarsalgia. An MSV radiograph is helpful to identify the plantar prominence of metatarsal which can be associated with poor clinical outcomes.     

Metatarsal neck osteotomy for metatarsalgia

Surgical principle This osteotomy is performed to relieve the pressure exerted by one or more metatarsal heads on the overlying sole of the foot. This pressure can lead to painful plantar callosities. Through a transverse dorsal approach a V-shaped notch down to but not including the plantar cortex is created with a small rongeur. Through manual osteoclasia the head is tilted upward. Full weight bearing helps to maintain the metatarsal head in the corrected position. No internal fixation nor external immobilization are needed.      

Metatarsal neck osteotomy for metatarsalgia

Surgical Principles This osteotomy is performed to relieve the pressure exerted by one or more metatarsal heads on the overlying sole of the foot. This pressure can lead to painful plantar callosities. Through a transverse dorsal approach a V-shaped notch down to but not including the plantar cortex is created with a small rongeur. Through manual osteoclasia the head is tilted upward. Full weight bearing helps to maintain the metatarsal head in the corrected position. No internal fixation nor external immobilization are needed.     

Percutaneous distal osteotomy of lesser metatarsals (DMMO) for treatment of metatarsalgia with metatarsophalangeal instability

Background

Clinical and radiological results of percutaneous distal metatarsal minimally invasive osteotomy (DMMO) of the lesser rays for surgical treatment of primary metatarsalgia due to plantar overpressure with metatarsophalangeal instability are described. The aim of this prospective study was to assess the efficacy, feasibility and safety of this minimally invasive surgical (MIS) technique, verifying the possibility to lower the complication rate related to surgical exposures, to reduce operating times with comparable functional and cosmetic results to those reported with traditional open procedures.

A Retrospective Review of the Weil Metatarsal Osteotomy for Lesser Metatarsal Deformities: An Intermediate Follow-up Analysis

The purpose of this retrospective clinical study was to determine the clinical results of the Weil metatarsal osteotomy. There were 51 patients (89 procedures), consisting of 10 males and 41 females, with a mean 53.1 +/- 11.9 years. Patients were evaluated for subjective improvement on a scale from 0 to 10, and asked if they would repeat the procedure. They were evaluated functionally using the American Orthopedic Foot and Ankle Society's lesser metatarsal rating scale, and assessed for toe purchase and range of motion. Thirty-nine point two percent of patients reported a complete resolution of pain (10/10 points), with 13.7% reporting a score of < or = 5/10. Eighty percent of the patients would repeat the procedure. The most common complication was toe elevation in 33% of patients. Joint range of motion was reduced in most cases. Thirty five patients experienced no pain at end range of motion, 6 related significant pain and 9 patients experienced some pain. Patients who underwent the procedure as a prophylactic measure along with a first ray procedure formed a significant subgroup (31%). These patients also scored well in comparison to the remainder of patients, with a mean subjective score of 8.4/10 as compared with 7.9/10 for the remainder of patients. The prophylactic group also demonstrated a median functional rating scale score of 90, versus 80 for the remainder of patients. These findings suggest that the Weil metatarsal osteotomy is a useful procedure for metatarsalgia and may also be useful in preventing lesser metatarsalgia in conjunction with first metatarsal surgery.