第二趾跖板慢性撕裂损伤的手术修复_《中国修复重建外科杂志》

作者：

俞光荣 , 郁耀平 , 张鹏 , 杨云峰 , 李兵 , 张明珠

同济大学附属同济医院骨科（上海，200065）;

关键词：

第2趾跖板慢性撕裂损伤跖趾关节软组织修复

DOI：

10.7507/1002-1892.20130317

视频：

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目的探讨第2趾跖板慢性撕裂损伤手术修复方法及近期疗效。方法 2012年6月－2013年6月，收治第2趾跖板慢性撕裂损伤14例。男4例，女10例；年龄51～82岁，平均65.9岁。左侧5例，右侧9例。病程5～9 年，平均6.2年。单纯第2趾锤状趾1例；（足母）外翻合并第2趾爪形趾2例，（足母）外翻合并第2趾锤状趾11例。均合并第2跖趾关节不稳。改良Lachman试验及牵拉试验均呈阳性。作第2趾背侧切口首先纠正（足母）外翻后，行Weil截骨联合缝合修复跖板。结果术后患者切口均Ⅰ期愈合。12例患者获随访，随访时间6～12个月，平均8.2个月。（足母）外翻及爪形趾、锤状趾畸形均获得矫正，术后3个月改良Lachman试验及牵拉试验均呈阴性。术后6个月2例第2跖趾关节出现轻度疼痛，足趾活动无僵硬感。末次随访时，按照美国矫形足踝协会（AOFAS）的前中足评分标准为（90.50 ± 3.73）分，明显高于术前的（57.33 ± 4.99）分，差异有统计学意义（t=21.724，P=0.000）。结论跖板是维持跖趾关节稳定的关键结构，手术缝合修复治疗第2趾跖板慢性撕裂损伤可获得较好近期疗效。

引用本文： 俞光荣,郁耀平,张鹏,杨云峰,李兵,张明珠. 第二趾跖板慢性撕裂损伤的手术修复. 中国修复重建外科杂志, 2013, 27(12): 1446-1449. doi: 10.7507/1002-1892.20130317 复制

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.

《中国修复重建外科杂志》

第二趾跖板慢性撕裂损伤的手术修复

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《中国修复重建外科杂志》

第二趾跖板慢性撕裂损伤的手术修复

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