第二趾跖板慢性撕裂損傷的手術修復_《中國修復重建外科雜志》

作者：

俞光榮 , 郁耀平 , 張鵬 , 楊云峰 , 李兵 , 張明珠

同濟大學附屬同濟醫院骨科（上海，200065）;

關鍵詞：

第2趾跖板慢性撕裂損傷跖趾關節軟組織修復

DOI：

10.7507/1002-1892.20130317

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目的探討第2趾跖板慢性撕裂損傷手術修復方法及近期療效。方法 2012年6月－2013年6月，收治第2趾跖板慢性撕裂損傷14例。男4例，女10例；年齡51～82歲，平均65.9歲。左側5例，右側9例。病程5～9 年，平均6.2年。單純第2趾錘狀趾1例；（足母）外翻合并第2趾爪形趾2例，（足母）外翻合并第2趾錘狀趾11例。均合并第2跖趾關節不穩。改良Lachman試驗及牽拉試驗均呈陽性。作第2趾背側切口首先糾正（足母）外翻后，行Weil截骨聯合縫合修復跖板。結果術后患者切口均Ⅰ期愈合。12例患者獲隨訪，隨訪時間6～12個月，平均8.2個月。（足母）外翻及爪形趾、錘狀趾畸形均獲得矯正，術后3個月改良Lachman試驗及牽拉試驗均呈陰性。術后6個月2例第2跖趾關節出現輕度疼痛，足趾活動無僵硬感。末次隨訪時，按照美國矯形足踝協會（AOFAS）的前中足評分標準為（90.50 ± 3.73）分，明顯高于術前的（57.33 ± 4.99）分，差異有統計學意義（t=21.724，P=0.000）。結論跖板是維持跖趾關節穩定的關鍵結構，手術縫合修復治療第2趾跖板慢性撕裂損傷可獲得較好近期療效。

引用本文： 俞光榮,郁耀平,張鵬,楊云峰,李兵,張明珠. 第二趾跖板慢性撕裂損傷的手術修復. 中國修復重建外科雜志, 2013, 27(12): 1446-1449. doi: 10.7507/1002-1892.20130317 復制

1.	Baravarian B, Thompson J, Nazarian D. Plantar plate tears: a review of the modified flexor tendon transfer repair for stabilization. Clin Podiatr Med Surg, 2011, 28(1): 57-68.
2.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
3.	Sanhudo JA, Ellera Gomes JL. Pull-out technique for plantar plate repair of the metatarsophalangeal joint. Foot Ankle Clin, 2012, 17(3): 417-424.
4.	Deland JT, Lee KT, Sobel M, et al. Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int, 1995, 16(8): 480-486.
5.	Joseph R, Schroeder K, Greenberg M. A retrospective analysis of lesser metatarsophalangeal joint fusion as a treatment option for hammertoe pathology associated with metatarsophalangeal joint instability. J Foot Ankle Surg, 2012, 51(1): 57-62.
6.	Ford LA, Collins KB, Christensen JC. Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate. J Foot Ankle Surg, 1998, 37(3): 217-222.
7.	Kernbach KJ. Hammertoe surgery: arthroplasty, arthrodesis or plantar plate repair. Clin Podiatr Med Surg, 2012, 29(3): 355-366.
8.	Coughlin MJ, Schutt SA, Hirose CB, et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int, 2012, 33(2): 133-140.
9.	Sung W, Weil L Jr, Weil LS Sr, et al. Diagnosis of plantar plate injury by magnetic resonance imaging with reference to intraoperative findings. J Foot Ankle Surg, 2012, 51(5): 570-574.
10.	Klein EE, Weil L Jr, Weil LS Sr, et al. Magnetic resonance imaging versus musculoskeletal ultrasound for identification and localization of plantar plate tears. Foot Ankle Spec, 2012, 5(6): 359-365.
11.	Gregg JM, Silberstein M, Schneider T, et al. Sonography of plantar plates in cadavers: correlation with MRI and histology. AJR Am J Roentgenol, 2006, 186(4): 948-955.
12.	Sonnery-Cottet B, Archbold P, Thaunat M, et al. Fifth toe plantar plate repair in a professional soccer player: case report. Foot Ankle Int, 2012, 33(7): 598-601.
13.	Lui TH. Arthroscopic-assisted correction of claw toe or overriding toe deformity: plantar plate tenodesis. Arch Orthop Trauma Surg, 2007, 127(9): 823-826.
14.	Lui TH, Chan LK, Chan KB. Modified plantar plate tenodesis for correction of claw toe deformity. Foot Ankle Int, 2010, 31(7): 584-591.
15.	Queally JM, Zgraj OS, Walsh JC, et al. Use of the modified Stainsby procedure in correcting severe claw toe deformity in the rheumatoid foot: a retrospective review. Foot (Edinb), 2009, 19(2): 110-113.
16.	Gregg J, Silberstein M, Clark C, et al. Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability. Foot and Ankle Surgery, 2007, 13(3): 116-121.
17.	Weil L Jr, Sung W, Weil LS Sr, et al. Anatomic plantar plate repair using the Weil metatarsal osteotomy approach. Foot Ankle Spec, 2011, 4(3): 145-1450.
18.	Nery C, Coughlin MJ, Baumfeld D, et al. Lesser metatarsophalangeal joint instability: prospective evaluation and repair of plantar plate and capsular insufficiency. Foot Ankle Int, 2012, 33(4): 301-311.

1. Baravarian B, Thompson J, Nazarian D. Plantar plate tears: a review of the modified flexor tendon transfer repair for stabilization. Clin Podiatr Med Surg, 2011, 28(1): 57-68.
2. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
3. Sanhudo JA, Ellera Gomes JL. Pull-out technique for plantar plate repair of the metatarsophalangeal joint. Foot Ankle Clin, 2012, 17(3): 417-424.
4. Deland JT, Lee KT, Sobel M, et al. Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int, 1995, 16(8): 480-486.
5. Joseph R, Schroeder K, Greenberg M. A retrospective analysis of lesser metatarsophalangeal joint fusion as a treatment option for hammertoe pathology associated with metatarsophalangeal joint instability. J Foot Ankle Surg, 2012, 51(1): 57-62.
6. Ford LA, Collins KB, Christensen JC. Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate. J Foot Ankle Surg, 1998, 37(3): 217-222.
7. Kernbach KJ. Hammertoe surgery: arthroplasty, arthrodesis or plantar plate repair. Clin Podiatr Med Surg, 2012, 29(3): 355-366.
8. Coughlin MJ, Schutt SA, Hirose CB, et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int, 2012, 33(2): 133-140.
9. Sung W, Weil L Jr, Weil LS Sr, et al. Diagnosis of plantar plate injury by magnetic resonance imaging with reference to intraoperative findings. J Foot Ankle Surg, 2012, 51(5): 570-574.
10. Klein EE, Weil L Jr, Weil LS Sr, et al. Magnetic resonance imaging versus musculoskeletal ultrasound for identification and localization of plantar plate tears. Foot Ankle Spec, 2012, 5(6): 359-365.
11. Gregg JM, Silberstein M, Schneider T, et al. Sonography of plantar plates in cadavers: correlation with MRI and histology. AJR Am J Roentgenol, 2006, 186(4): 948-955.
12. Sonnery-Cottet B, Archbold P, Thaunat M, et al. Fifth toe plantar plate repair in a professional soccer player: case report. Foot Ankle Int, 2012, 33(7): 598-601.
13. Lui TH. Arthroscopic-assisted correction of claw toe or overriding toe deformity: plantar plate tenodesis. Arch Orthop Trauma Surg, 2007, 127(9): 823-826.
14. Lui TH, Chan LK, Chan KB. Modified plantar plate tenodesis for correction of claw toe deformity. Foot Ankle Int, 2010, 31(7): 584-591.
15. Queally JM, Zgraj OS, Walsh JC, et al. Use of the modified Stainsby procedure in correcting severe claw toe deformity in the rheumatoid foot: a retrospective review. Foot (Edinb), 2009, 19(2): 110-113.
16. Gregg J, Silberstein M, Clark C, et al. Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability. Foot and Ankle Surgery, 2007, 13(3): 116-121.
17. Weil L Jr, Sung W, Weil LS Sr, et al. Anatomic plantar plate repair using the Weil metatarsal osteotomy approach. Foot Ankle Spec, 2011, 4(3): 145-1450.
18. Nery C, Coughlin MJ, Baumfeld D, et al. Lesser metatarsophalangeal joint instability: prospective evaluation and repair of plantar plate and capsular insufficiency. Foot Ankle Int, 2012, 33(4): 301-311.

《中國修復重建外科雜志》

第二趾跖板慢性撕裂損傷的手術修復

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《中國修復重建外科雜志》

第二趾跖板慢性撕裂損傷的手術修復

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