CAJ | 학술논문

背景:跖骨头骨软骨病,又称跖骨头骨坏死,对于跖骨头关节面出现塌陷的晚期患者目前大都主张手术治疗,早期患者主张保守治疗.但对于疼痛严重的早期患者的治疗则存在争议.目的:探讨Jacoby截骨术治疗早期跖骨头骨软骨病的临床疗效,从而为临床上更加合理有效地治疗跖骨头骨软骨病提供方法和依据.方法:2008年6月至2014年9月,我院采用Jacoby截骨术治疗早期跖骨头骨软骨病患者25例,其中18例(21足)临床资料完整并获随访.女14例(17足),男4例(4足);年龄29~58岁,平均36.3岁.单侧15例,双侧3例;病变发生于第2跖骨头15足,第3跖骨头5足,第4跖骨头处1足;合并外翻畸形16足,趾间神经瘤或神经卡压5足.所有患者均有相应足趾处疼痛,且病史1年以上.负重位X线片依据Smillie分期:Ⅱ期13足,Ⅲ期8足.测量并记录术前、术后跖趾关节背伸、跖屈角度.根据美国足踝外科协会Maryland跖趾关节百分评分法对术后足部功能改善情况进行评定.结果:随访时间14~72个月,平均38.4个月.术后患者跖趾关节处疼痛消失,活动自如,术前跖趾关节活动度:背伸30.6°±1.87°,跖屈34.3°±2.96°;术后:背伸32.9°±1.67°,跖屈36.7°±1.17°,术后与术前跖趾关节活动度比较,差异无统计学意义(P>0.05).Maryland评分:优16足(76.2%),良5足(23.8%).结论:对于年轻且处于Smillie分期早期的跖骨头骨软骨病患者,Jacoby截骨术可取得满意、确切的治疗效果,并且手术操作简单,截骨处稳定,仅用1枚螺钉固定即可.
배경:척골두골연골병,우칭척골두골배사,대우척골두관절면출현탑함적만기환자목전대도주장수술치료,조기환자주장보수치료.단대우동통엄중적조기환자적치료칙존재쟁의.목적:탐토Jacoby절골술치료조기척골두골연골병적림상료효,종이위림상상경가합리유효지치료척골두골연골병제공방법화의거.방법:2008년6월지2014년9월,아원채용Jacoby절골술치료조기척골두골연골병환자25례,기중18례(21족)림상자료완정병획수방.녀14례(17족),남4례(4족);년령29~58세,평균36.3세.단측15례,쌍측3례;병변발생우제2척골두15족,제3척골두5족,제4척골두처1족;합병 외번기형16족,지간신경류혹신경잡압5족.소유환자균유상응족지처동통,차병사1년이상.부중위X선편의거Smillie분기:Ⅱ기13족,Ⅲ기8족.측량병기록술전、술후척지관절배신、척굴각도.근거미국족과외과협회Maryland척지관절백분평분법대술후족부공능개선정황진행평정.결과:수방시간14~72개월,평균38.4개월.술후환자척지관절처동통소실,활동자여,술전척지관절활동도:배신30.6°±1.87°,척굴34.3°±2.96°;술후:배신32.9°±1.67°,척굴36.7°±1.17°,술후여술전척지관절활동도비교,차이무통계학의의(P>0.05).Maryland평분:우16족(76.2%),량5족(23.8%).결론:대우년경차처우Smillie분기조기적척골두골연골병환자,Jacoby절골술가취득만의、학절적치료효과,병차수술조작간단,절골처은정,부용1매라정고정즉가.
Background:Osteochondritis of the metatarsal head is also named as metatarsal head necrosis. It is suggested that the late-stage osteochondritis of metatarsal head should be treated by surgery, while the early-stage one usually be treated by a con-servative therapy. However, the treatment for early-stage osteochondritis of metatarsal head in which severe pain recurs is in dispute. Objective:To explore the curative effect of Jacoby osteotomy for the early-stage osteochondritis of metatarsal head, so as to provide evidence which is more reasonable and effective basis for clinical treatment for the disease. Methods:From June 2008 to September 2014, 25 patients with early-stage osteochondritis of metatarsal head were treated by Jacoby osteotomy in our hospital. Of them, 18 patients (21 feet) were followed up and their clinical data was complete. There were 14 females (17 feet) and 4 males (4 feet) aged from 29 to 58 years (mean, 36.3 years). Unilateral injury occurred in 15 patients and bilateral injuries in 3 patients. The lesions affected the second metatarsal head in 15 patients, the third metatarsal head in 5 patients and the fourth in 1 patient. Osteochondritis was complicated by hallux valgus in 16 cases and by Morton's neuroma in 5 cases. The pain occurred in the corresponding digit in all of the patients, and the medical history lasted for more than one year. According to the Smillie classification, there were 13 cases with gradeⅡosteonecrosis and 8 cases with gradeⅢ. Range of motion of metatarsophalangeal joint (MPJ) was measured before and after surgery. Postopera-tive foot function was evaluated based on Maryland scoring system of the AOFAS. Results:The mean duration of follow up was 38.4 months (range, 14-72 months). The MPJ pain disappeared and the joints could move freely. Postoperative dorsal flexion angle and plantar flexion angle were 32.9°±1.67° and 36.7°±1.17°, respec-tively, which was not statistically different from preoperative ones (30.6° ± 1.87° , 34.3° ± 2.96° , P>0.05). Postoperative foot function was excellent in 16 feet (76.2%) and good in 5 feet (23.8%) according to the Maryland scoring system.Conclusions:Jacoby osteotomy is a reliable treatment for young patients with Smillie early-stage osteochondritis of metatar-sal head. The operation is simple, and only one screw is used during the procedure.