【摘要】 目的探讨不同的手术方式治疗晚期Freiberg病的疗效。方法自2009-03—2014-12诊治63例跖骨头缺血性坏死。分为A、B、C 3组,A组接受跖骨颈背侧闭合截骨术,B组接受跖趾关节切除成形术,C组接受跖趾关节置换术。采用AOFAS-LMIS、跖趾关节活动度(MTP-ROM)及疼痛视觉模拟VAS评分对不同组间的疗效进行评估。跖骨的短缩以及截骨部位的愈合情况通过X线片进行评估。结果术后3组获得随访3~58个月,平均32.5个月,所有患者的疼痛及跖趾关节活动度得到明显改善。各组术前平均MTP-ROM均较本组术后MTP-ROM低,差异有统计学意义(P<0.05);术后组间比较A组与C组跖趾关节活动度差异无统计学意义(P>0.05);A组、C组术后关节活动度分别小于B组,差异有统计学意义(P<0.05)。各组术前AOFAS评分均较本组术后评分低(P<0.05);A组与B组术后评分比较差异无统计学意义(P>0.05);A组、B组术后评分分别小于C组,差异有统计学意义(P<0.05)。各组术前VAS评分均较本组术后高(P<0.05);术后A组、B组VAS评分分别高于C组,差异有统计学意义(P<0.05);术后A组与B组部分患者出现转移性跖骨痛并发症,C组未出现相关并发症。结论 3种术式均能够显著改善晚期Freiberg病的跖骨痛症状及跖趾关节活动度,跖趾关节置换术在改善关节活动度方面虽然弱于关节成形术,但在改善跖趾关节功能及症状方面较关节成形术和背侧截骨术更明显。更多还原

【Abstract】 Objective To explore the effect of different surgical methods for treatment of advanced Freiberg’s disease.Methods From Mar. 2009 to Dec. 2014, 63 patients who suffered metatarsal head avascular necrosis were recruited. They were equally divided into group A, B, C. Group A underwent closing wedge osteotomy on the back of second metatarsal neck; group B received second metatarsal phalangeal joint arthroplasty; group C received metatarsal phalangeal joint replacement. The results between any different two groups were evaluated, according to AOFAS-LMIS, MTP-ROM and VAS criteria. Metatarsal shortening and the healing condition of osteomy site were evaluated by X-ray. Results Follow-up time lasted 3-58 months,mean time was 32.5 months. Good pain relief was achieved and MTP-ROM was significantly improved. In each group, the mean MTP-ROM in each group before operation was statistically lower than that after operation(P <0.05); Differences in MTP-ROM between group A and C were not statistically significant(P >0.05). MTP-ROM after operation in group A or C respectively was statistically lower than group B(P <0.05). Meanwhile, AOFAS scoring in each group before operation was statistically lower than that after operation(P <0.05), but differences in AOFAS scoring between group A and B were not statistically significant(P >0.05).Either group A or B AOFAS scoring after operation was statistically lower than group C(P <0.05). Some patients in group A and B after operation suffered metastatic metatarsalgia, but there were no complications appeared in group C. Conclusion By this study, we found that all the surgical methods above could obviously improved the symptom and MTP-ROM of later period of Freiberg’s disease; Metatarsal phalangeal joint replacement is regarded as inferior to metatarsal phalangeal joint arthroplasty on improving MTP-ROM, but far surpasses others on improving MTP function and symptom.更多还原