跖骨缓慢延长植骨治疗严重跖骨短小畸形

目的：探讨跖骨缓慢延长植骨治疗严重跖骨短小症的效果，并介绍该手术方法的优点。方法2006年至2012年，共治疗10例14根跖骨短小，其中双侧第四跖骨短缩4例，单侧第四跖骨短缩5例，第一跖骨短缩1例，女9例，男1例，年龄13～30岁。纳入标准：跖骨短缩＞20 mm。术前跖骨X线测量：短缩2.0～2.7 cm，平均2.3 cm。本组10例中双侧第四跖骨短缩4例，单侧短缩5例，第一跖骨短缩1例；女9例，男1例；年龄13～30岁。第一阶段：足背侧入路，用微型摆锯在跖骨中部横行截骨，截骨后安装Orthofix单边外固定支架，术中牵开5 mm。术后第2天开始延长，每次0.5 mm，早晚各1次。此后2周改为早0.4 mm，晚0.35 mm各1次。第二阶段：延长至预期长度后取下外固定支架，取髂骨植骨，用微型钢板行内固定术。随访12～18个月，平均14个月。结果术后X线12周时14根跖骨中13根达到骨性愈合，18周时全部达到骨性愈合。平均延长22.5 mm，平均延长百分比为39.5％，跖骨得以抛物线恢复。按照美国足踝矫形外科协会（ the alnerican orthopedic foot and ankle society，AOFAS ）的功能评判标准，术前与术后12周采用配对t检验，差值的样本均数-50.29，P＜0.01，具有统计学意义。术后平均AOFAS评分为84.71分，8只足优，6只足良。无明显并发症，所有患者对延长结果、外形、前足功能恢复满意或基本满意。结论跖骨缓慢延长植骨治疗严重跖骨短小症能使短小的跖骨恢复到满意的长度，恢复快，并发症少，值得推荐。

Treatment of serious brachymetatarsia by gradual metatarsal elongation combined with bone graft

Objective To investigate the outcomes of gradual metatarsal elongation combined with bone graft in the treatment of serious brachymetatarsia, and to introduce the advantages of this operative method.Methods From 2006 to 2012, 10 patients with brachymetatarsia （ 14 metatarsals ） were treated, including 4 patients with bilateral brachymetatarsia of the 4th ray, 5 patients with unilateral brachymetatarsia of the 4th ray and 1 patient with brachymetatarsia of the 1st ray. There were 9 females and 1 male, whose age ranged from 13 to 30 years old. The inclusion criteria was that the metatarsal bone was shortened for over 20 mm. Based on the preoperative radiographs, the mean shortened length was 2.3 cm （ range： 2.0-2.7 cm ）. In the ifrst stage, metatarsal osteotomy was performed with the oscillating micro-saw in the middle part with the dorsal approach, and then the Orthoifx unilateral external fixator was installed. The traction of 5 mm was achieved during the operation. The extension was done from the 2nd day after the surgery at the rate of 0.5 mm twice a day, each morning and evening. The extended length was 0.4 mm in the morning and 0.35 mm in the evening 2 weeks later. In the second stage, the iliac bone graft was taken out and the external ifxator was removed when the metatarsal bone was extended to the expected length. The mini-plate was used in the internal ifxation. The mean follow-up period was 14 months （ range： 12-18 months ）.Results The postoperative radiographs showed bony union was achieved in 13 of 14 metatarsals at 12 weeks, and in all 14 metatarsals at 18 weeks after the operation. The mean extended length was 22.5 mm and the mean percentage of extension was 39.5%. Parabolic recovery was realized in the metatarsals. The function was evaluated according to the standard of the American Orthopedic Foot and Ankle Society （ AOFAS ）. The paired t-test was used to analyze the scores preoperatively and at 12 weeks after the operation. The sample mean of the difference values was -50.29, a