CAJ | 학술논문

目的：探讨外翻术后发生转移性跖痛症的原因及Weil截骨术治疗外翻术后转移性跖痛症的临床疗效。方法回顾性分析2009年7月至2012年1月，采用Weil截骨术治疗27例外翻术后第二至四跖骨头下转移性跖痛症患者资料，男1例，女26例；年龄28~73岁，平均51岁；均为单足发病。跖痛症均发生在外翻术后6~24个月。其中13例采用微创第一跖骨颈楔形截骨术、7例采用Chevron术、5例采用Akin术、2例采用Lapidus术矫正外翻畸形；术后除5例采用Akin截骨患者因未做第一跖骨截骨而未出现跖骨短缩外，其余22例均出现第一跖骨短缩现象。采用美国足踝外科协会（American Orthopaedic Foot and Ankle Society, AOFAS）趾-跖趾-趾间关节评分及视觉模拟评分（visual analogue scale, VAS）评价手术效果，采用足底压力测试仪测试术前及术后足底压力改变。结果术后25例获得完整随访，随访时间12~48个月，平均24个月。23例跖痛完全消失；2例术后再次出现外侧跖骨头转移性跖痛症，其中1例经垫前足减压垫后疼痛缓解，1例再次行Weil截骨术后疼痛消失。患者术前AOFAS趾-跖趾-趾间关节评分、VAS评分分别为（46.82±6.13）分和7.5（6，7）分，术后末次随访时分别为（90.63±1.65）分和0.5（0，1.0）分。末次随访根据AOFAS趾-跖趾-趾间关节评分，其中23例为优，1例为良，1例为可；优良率为96%（24/25）。手术前、后足趾推进期趾及第二至五趾跖骨头下压力，术前依次为（3.12±1.62）Pa、（5.81±1.92）Pa、（4.63±2.10）Pa、（3.37±1.57）Pa、（1.67±1.20）Pa，术后依次为（3.33±1.35） Pa、（3.89±1.08）Pa、（3.65±1.96）Pa、（2.25±1.23）Pa、（1.48±1.11）Pa；术后跖骨头下压力较术前明显降低。结论 Weil截骨术可有效调节跖骨长度和跖骨头高度，改善疼痛跖骨头下应力，对治疗外翻术后转移性跖痛症有良好疗效。目的：探討外翻術後髮生轉移性蹠痛癥的原因及Weil截骨術治療外翻術後轉移性蹠痛癥的臨床療效。方法迴顧性分析2009年7月至2012年1月，採用Weil截骨術治療27例外翻術後第二至四蹠骨頭下轉移性蹠痛癥患者資料，男1例，女26例；年齡28~73歲，平均51歲；均為單足髮病。蹠痛癥均髮生在外翻術後6~24箇月。其中13例採用微創第一蹠骨頸楔形截骨術、7例採用Chevron術、5例採用Akin術、2例採用Lapidus術矯正外翻畸形；術後除5例採用Akin截骨患者因未做第一蹠骨截骨而未齣現蹠骨短縮外，其餘22例均齣現第一蹠骨短縮現象。採用美國足踝外科協會（American Orthopaedic Foot and Ankle Society, AOFAS）趾-蹠趾-趾間關節評分及視覺模擬評分（visual analogue scale, VAS）評價手術效果，採用足底壓力測試儀測試術前及術後足底壓力改變。結果術後25例穫得完整隨訪，隨訪時間12~48箇月，平均24箇月。23例蹠痛完全消失；2例術後再次齣現外側蹠骨頭轉移性蹠痛癥，其中1例經墊前足減壓墊後疼痛緩解，1例再次行Weil截骨術後疼痛消失。患者術前AOFAS趾-蹠趾-趾間關節評分、VAS評分分彆為（46.82±6.13）分和7.5（6，7）分，術後末次隨訪時分彆為（90.63±1.65）分和0.5（0，1.0）分。末次隨訪根據AOFAS趾-蹠趾-趾間關節評分，其中23例為優，1例為良，1例為可；優良率為96%（24/25）。手術前、後足趾推進期趾及第二至五趾蹠骨頭下壓力，術前依次為（3.12±1.62）Pa、（5.81±1.92）Pa、（4.63±2.10）Pa、（3.37±1.57）Pa、（1.67±1.20）Pa，術後依次為（3.33±1.35） Pa、（3.89±1.08）Pa、（3.65±1.96）Pa、（2.25±1.23）Pa、（1.48±1.11）Pa；術後蹠骨頭下壓力較術前明顯降低。結論 Weil截骨術可有效調節蹠骨長度和蹠骨頭高度，改善疼痛蹠骨頭下應力，對治療外翻術後轉移性蹠痛癥有良好療效。
목적：탐토외번술후발생전이성척통증적원인급Weil절골술치료외번술후전이성척통증적림상료효。방법회고성분석2009년7월지2012년1월，채용Weil절골술치료27례외번술후제이지사척골두하전이성척통증환자자료，남1례，녀26례；년령28~73세，평균51세；균위단족발병。척통증균발생재외번술후6~24개월。기중13례채용미창제일척골경설형절골술、7례채용Chevron술、5례채용Akin술、2례채용Lapidus술교정외번기형；술후제5례채용Akin절골환자인미주제일척골절골이미출현척골단축외，기여22례균출현제일척골단축현상。채용미국족과외과협회（American Orthopaedic Foot and Ankle Society, AOFAS）지-척지-지간관절평분급시각모의평분（visual analogue scale, VAS）평개수술효과，채용족저압력측시의측시술전급술후족저압력개변。결과술후25례획득완정수방，수방시간12~48개월，평균24개월。23례척통완전소실；2례술후재차출현외측척골두전이성척통증，기중1례경점전족감압점후동통완해，1례재차행Weil절골술후동통소실。환자술전AOFAS지-척지-지간관절평분、VAS평분분별위（46.82±6.13）분화7.5（6，7）분，술후말차수방시분별위（90.63±1.65）분화0.5（0，1.0）분。말차수방근거AOFAS지-척지-지간관절평분，기중23례위우，1례위량，1례위가；우량솔위96%（24/25）。수술전、후족지추진기지급제이지오지척골두하압력，술전의차위（3.12±1.62）Pa、（5.81±1.92）Pa、（4.63±2.10）Pa、（3.37±1.57）Pa、（1.67±1.20）Pa，술후의차위（3.33±1.35） Pa、（3.89±1.08）Pa、（3.65±1.96）Pa、（2.25±1.23）Pa、（1.48±1.11）Pa；술후척골두하압력교술전명현강저。결론 Weil절골술가유효조절척골장도화척골두고도，개선동통척골두하응력，대치료외번술후전이성척통증유량호료효。
Objective To investigate the cause of metastatic metatarsalgia after hallux valgus surgery and the clinical outcomes of Weil osteotomy for metastatic metatarsalgia after hallux valgus surgery. Methods From July 2009 to Janurary 2012, data of 27 patients (27 feet) with metastatic metatarsalgia of 2nd to 4th head of metatarsal bone after hallux valgus surgery who had been treated by Weil osteotomy were retrospectively analyzed. There were 1 male and 26 females with an average age of 51 years (range, 28-73 years). Metatarsalgia occurred 6-24 months after operation for hallux valgus. 13 feet underwent mini-invasive cervi-cal wedge osteotomy of the first metatarsal, 7 with Chevron procedure, 5 with Akin procedure, and 2 with Lapidus procedure. No shortening in first metatarsal was found in 5 feet with Akin osteotomy, while there were varying degrees of shortening in first meta-tarsal in the remaining 22 feet. The clinical results were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores. The preoperative and postoperative plantar pressure changes were tested by plantar pressure tester. Results 25 Patients were followed up for 12-42 months (average, 24 months). Among these 25 cases, the metatarsalgia of 23 cases were completely disappeared. The metatarsal plantar lateral metastatic pain occurred in the remaining 2 cases (2 feet) and 1 was relieved by the foot pad, 1 was cured by re-Weil osteotomy. AOFAS score was 46.82 ± 6.13 before surgery and 90.63 ± 1.65 after surgery. The VAS score was 7.5 (6, 7) before surgery and 0.5 (0, 1.0) after surgery. The last follow-up, according to the score of AOFAS toe metatarsophalangeal-interphalangeal joint, of which 23 cases were excellent, 1 good, 1 poor;the excellent and good rate was 96%(24/25). Preoperative pressure under 2nd to 5th metatarsal head were 3.12±1.62 Pa, 5.81±1.92 Pa, 4.63± 2.10 Pa, 3.37±1.57 Pa, 1.67±1.20 Pa and postoperative were 3.33±1.35 Pa, 3.89±1.08 Pa, 3.65±1.96 Pa, 2.25±1.23, (1.48±1.11) Pa. Postoperative pressure under 2nd to 5th metatarsal head were significantly decreased. Conclusion Weil osteotomy can effec-tively adjust the length of the metatarsal and the height of metatarsal head, thus effectively improve the pressure under the metatar-sal head, so it could reach a good effect in the treatment of metastatic metatarsalgia after hallux valgus surgery.