摘要
背景：跖骨头骨软骨病,又称跖骨头骨坏死,对于跖骨头关节面出现塌陷的晚期患者目前大都主张手术治疗,早期患者主张保守治疗。但对于疼痛严重的早期患者的治疗则存在争议。目的：探讨Jacoby截骨术治疗早期跖骨头骨软骨病的临床疗效,从而为临床上更加合理有效地治疗跖骨头骨软骨病提供方法和依据。方法：2008年6月至2014年9月,我院采用Jacoby截骨术治疗早期跖骨头骨软骨病患者25例,其中18例（21足）临床资料完整并获随访。女14例（17足）,男4例（4足）;年龄29~58岁,平均36.3岁。单侧15例,双侧3例;病变发生于第2跖骨头15足,第3跖骨头5足,第4跖骨头处1足;合并外翻畸形16足,趾间神经瘤或神经卡压5足。所有患者均有相应足趾处疼痛,且病史1年以上。负重位X线片依据Smillie分期：Ⅱ期13足,Ⅲ期8足。测量并记录术前、术后跖趾关节背伸、跖屈角度。根据美国足踝外科协会Maryland跖趾关节百分评分法对术后足部功能改善情况进行评定。结果：随访时间14~72个月,平均38.4个月。术后患者跖趾关节处疼痛消失,活动自如,术前跖趾关节活动度：背伸30.6°±1.87°,跖屈34.3°±2.96°;术后：背伸32.9°±1.67°,跖屈36.7°±1.17°,术后与术前跖趾关节活动度比较,差异无统计学意义（P〉0.05）。Maryland评分：优16足（76.2%）,良5足（23.8%）。结论：对于年轻且处于Smillie分期早期的跖骨头骨软骨病患者,Jacoby截骨术可取得满意、确切的治疗效果,并且手术操作简单,截骨处稳定,仅用1枚螺钉固定即可。
Background： Osteochondritis of the metatarsal head is also named as metatarsal head necrosis. It is suggested that the latestage osteochondritis of metatarsal head should be treated by surgery, while the early-stage one usually be treated by a conservative therapy. However, the treatment for early-stage osteochondritis of metatarsal head in which severe pain recurs is in dispute.Objective： To explore the curative effect of Jacoby osteotomy for the early-stage osteochondritis of metatarsal head, so as to provide evidence which is more reasonable and effective basis for clinical treatment for the disease.Methods： From June 2008 to September 2014, 25 patients with early-stage osteochondritis of metatarsal head were treated by Jacoby osteotomy in our hospital. Of them, 18 patients（21 feet） were followed up and their clinical data was complete.There were 14 females（17 feet） and 4 males（4 feet） aged from 29 to 58 years（mean, 36.3 years）. Unilateral injury occurred in 15 patients and bilateral injuries in 3 patients. The lesions affected the second metatarsal head in 15 patients, the third metatarsal head in 5 patients and the fourth in 1 patient. Osteochondritis was complicated by hallux valgus in 16 cases and by Morton＇s neuroma in 5 cases. The pain occurred in the corresponding digit in all of the patients, and the medical history lasted for more than one year. According to the Smillie classification, there were 13 cases with grade Ⅱ osteonecrosis and 8cases with grade Ⅲ. Range of motion of metatarsophalangeal joint（MPJ） was measured before and after surgery. Postoperative foot function was evaluated based on Maryland scoring system of the AOFAS.Results： The mean duration of follow up was 38.4 months（range, 14-72 months）. The MPJ pain disappeared and the joints could move freely. Postoperative dorsal flexion angle and plantar flexion angle were 32.9°±1.67° and 36.7°±1.17°, respectively, which was not statistically different from preoperative ones（30.6°±1.87°, 34.3°±2.96°, P0.05）. Postoperative foot function was excellent in 16 feet（76.2%） and good in 5 feet（23.8%） according to the Maryland scoring system.Conclusions： Jacoby osteotomy is a reliable treatment for young patients with Smillie early-stage osteochondritis of metatarsal head. The operation is simple, and only one screw is used during the procedure.
出处
《中国骨与关节外科》
2015年第4期320-322,326,共4页
Chinese Journal of Bone and Joint Surgery
