跖趾关节成形克氏针固定治疗晚期Freiberg病

Metatarsophalangeal arthroplasty with Kirschner wire fixation for advanced Freiberg disease

摘要:

[目的] 介绍跖趾关节成形克氏针固定治疗中晚期 Freiberg 病的手术技术和初步临床结果。[方法] 2020 年 3 月— 2023 年 12 月 20 例 Freiberg 病的患者均采用阴阳锉辅助进行跖趾关节塑形联合克氏针固定治疗。手术采用患侧跖趾关节背侧纵行切口，逐层切开，保护趾长伸肌腱并牵开，从背侧切开跖趾关节囊，显露跖趾关节间隙，清除跖趾关节周围游离剥脱的软骨游离体，脱位跖趾关节，用阴锉打磨跖骨头，剔除表面部分软骨及硬化骨，修整肥大增生骨赘至跖骨头圆滑，经皮斜行穿入 1~2 枚钛针固定跖趾关节，用周围的脂肪、切断的跖短伸肌腱及部分关节囊组织填充跖趾关节间隙，全层缝合切口。[结果] 所有患者均获得随访，随访时间平均（20.1±11.2）个月。AOFAS 评分由术前的（68.7±6.1）分显著提高到术后 6 个月的（91.0± 4.2） 分 （P＜0.05）；与术前相比，术后 6 个月跖趾关节跖屈、背伸活动度差异无统计学意义 （P＞0.05）。[结论] 采用阴阳锉辅助进行跖趾关节塑形联合克氏针固定治疗中晚期 Freiberg 病，创伤小，操作简单，是较为可靠的一种治疗方案。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of metatarsophalangeal arthroplasty with Kirschner wire fixation in the treatment of advanced Freiberg disease. [Methods] From March 2020 to December 2023, 20 patients with end-stage Freiberg disease underwent metatarsophalangeal shaping with the concave-convex reamers and Kirschner wire fixation. A longitudinal incision was made on the dorsal side of the metatarsophalangeal joint of the affected side, which was made layer by layer to protect and retract the extensor digitorum longus tendon. The metatarsophalangeal capsule was cut from the back side to expose the the metatarso-phalangeal space, remove the free and exfoliated cartilage around the joint. Displace the joint, polish the metatarsal head with the concave reamer, while the phalangeal base with convex reamer to remove the cartilage and hardened bone, and trim the hyperplastic osteophyte until the metatarsal head and phalangeal base became smooth. The metatarsophalangeal joint was fixed by one or two percutaneous titanium Kirschner wires, with the joint space filled with the surrounding fat tissue, severed extensor brevis tendon and part of capsule tissue. [Results] All patients were operated on smoothly and followed up for an average of (20.1±11.2) months. AOFAS score was significantly increased from (68.7±6.1) before surgery to (91.0±4.2) 6 months postoperatively (P＜0.05). There was no significant change in plantar flexiondorsal extension range of motion of the joint 6 months after operation compared with that before operation (P＞0.05). [Conclusion] This metatarsophalangeal arthroplasty with concave-convex reamers combined with Kirschner wire fixation for advanced Freiberg disease is a relatively reliable treatment with benefits of less trauma and simple operation.