■Bunionette畸形(BD)是第五meta骨的疼痛状况,其特征是骨突出和第五脚趾内翻畸形。这项研究的目的是评估临床,功能,经皮远端跖骨干meta端截骨术(DMMO)的影像学结果,无需固定或术后绑扎脚。
■对111例(132英尺)有症状的BD患者进行了回顾性病例系列研究,这些患者在2020年9月至2022年1月期间由经验丰富的微创外科医生对第五跖骨进行了经皮DMMO。根据Shimobayashi分类,我们治疗了1例I型畸形,37II型畸形,52III型畸形,42英尺患有IV型畸形,也没有V型畸形的病人.90例(81%)患者接受了单侧截骨术,21例(19%)进行了双侧截骨术。大多数病例包括其他程序,包括治疗114个相关的畸形的相同的脚:12个较小的meta骨切开术(2-3-4meta骨),和34个锤头(20秒锤头,10第三个锤头,1第四锤头,2第五个锤头)。患者报告的临床结果指标,包括足部功能指数(FFI)问卷,视觉模拟评分(VAS),并收集了总体满意度。第四至第五meta骨间角(IMA)矫正,骨头愈合的时间,评估所有患者的并发症发生率。
■平均随访时间为24.1个月(范围,14-39个月)。DMMO手术后,影像学参数和患者报告的结果指标均显着改善。平均第四至第五IMA从12.2度提高,术前,到4.4度,术后(P<0.001)。患者结果反映了基于每个患者的联合手术的总体结果。术前,患者的平均VAS评分为7.6分,末次随访时改善为0.6分(P<.001).此外,平均FFI从术前到术后分别从19.2降至4.4(P<.001)。总的来说,111例患者中有108例报告对手术结果感到满意。术后12.6周达到平均骨愈合,最少12周,最多25周。并发症发生率为1.5%,包括1例无症状性旋塞畸形和1例外侧第五跖骨干骨悬垂疼痛,通过手术来解决。
■这项对从有经验的外科医生进行微创手术的患者的研究结果表明,不进行内固定或术后固定或捆扎的第五meta骨的经皮DMMO可以有效地改善射线照相对准,疼痛,函数,和总体满意度,并发症发生率最低。
■四级,案例系列。
Bunionette deformity (BD) is a painful condition of the fifth metatarsal characterized by an osseous prominence and fifth toe varus deformity. The purpose of this study is to assess the clinical, functional, and radiographic outcomes of percutaneous distal metatarsal metaphyseal osteotomy (DMMO) without fixation or postoperative strapping of the foot.
A retrospective case series was performed on 111 patients (132 feet) with symptomatic BD who underwent percutaneous DMMO of the fifth metatarsal from September 2020 to January 2022 by an experienced minimally invasive surgeon. According to the Shimobayashi classification, we treated 1 type I deformity, 37 type II deformities, 52 type III deformities, 42 feet with type IV deformity, and no patient with a type V deformity. Ninety patients (81%) underwent unilateral osteotomy, and 21 (19%) had bilateral osteotomies. Most cases included other procedures including treatment of 114 associated deformities of the same feet: 68 bunions, 12 lesser metatarsal osteotomies (2-3-4 metatarsals), and 34 hammertoes (20 second hammertoes, 10 third hammertoes, 1 fourth hammertoes, 2 fifth hammertoes). Patient-reported clinical outcome measures, including the Foot Function Index (FFI) questionnaire, the visual analog score (VAS), and overall satisfaction were collected. Fourth-to-fifth intermetatarsal angle (IMA) correction, time to bone union, and complication rates were assessed in all patients.
Mean follow-up was 24.1 months (range, 14-39 months). Both radiographic parameters and patient-reported outcome measures significantly improved after DMMO procedure. The average fourth-to-fifth IMA improved from 12.2 degrees, preoperatively, to 4.4 degrees, postoperatively (P < .001). Patient outcomes reflect the overall outcomes of the combined surgeries on a per-patient basis. Preoperatively, patients had a mean VAS score of 7.6, which improved to 0.6 at the last follow-up (P < .001). Furthermore, the average FFI significantly decreased from pre- to postoperation from 19.2 to 4.4, respectively (P < .001). Overall, 108 of 111 patients reported being satisfied with the outcomes of the procedure. Average bone union was achieved at 12.6 weeks postoperation, with a minimum of 12 and a maximum of 25 weeks. The complication rate was 1.5%, including 1 case of an asymptomatic cock-up deformity and 1 case of lateral fifth metatarsal shaft bone overhang pain, which resolved with an exostectomy.
The results of this study of patients who had minimally invasive surgery from an experienced surgeon suggest that percutaneous DMMO of the fifth metatarsal without internal fixation or postoperative immobilization or strapping can be effective at improving radiographic alignment, pain, function, and overall satisfaction with minimal rates of complication.
Level IV, case series.