Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability
Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability
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DOI：
10.1177/1071100716679110
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发表时间：
2017-03-01
影响因子：
2.7
通讯作者：
Coughlin, Michael J.
中科院分区：
文献类型：
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作者：
Flint, Wesley W.;Macias, David M.;Coughlin, Michael J.
背景：小跖趾关节不稳定是导致前足疼痛的常见原因。手术技术和器械的进步使通过背侧入路解剖治疗足底撕裂成为可能。我们的目标是从背侧入路评价足底钢板修补术(PPR)的主观、功能和放射学结果。方法：采用前瞻性病例系列研究，评估97足138个足底钢板撕裂患者的PPR结果。2例患者经背侧入路Weil截骨术。我们定期对患者进行12个月的随访，收集患者手术前后视觉模拟评分(VAS)、MTP活动范围(ROM)、纸拔出试验、美国矫形外科足踝协会(AOFAS)评分、满意度和放射学测量的数据。结果：术后12个月，80%的患者满意度评分为良至优。术前平均VAS疼痛评分为5.4/10，术后为1.5/10。术后平均AOFAS评分由49分提高到81分。术前平均活动度43度，术后平均活动度31度。42%的脚趾在手术前通过了纸拔出测试，12个月时通过了54%的测试。第2、3、4跖骨平均缩短2.4/3.1/1.2 mm。第2、3、4个关节术前平均MTP角为2/4.9/-1.3°，术后平均为7.4/9.6/0.2°。结论：经背侧入路修复足底钢板疗效可靠。PPR是解剖重建不稳定的小MTP关节韧带支撑的可行选择。证据级别：四级，有追溯性的病例系列。
Background: Lesser metatarsophalangeal (MTP) joint instability is a common cause of forefoot pain. Advances in operative technique and instrumentation have made it possible to anatomically treat plantar plate tears through a dorsal approach. Our goal was to evaluate the subjective, functional, and radiographic outcomes of plantar plate repair (PPR) from a dorsal approach.Methods: A prospective case series was performed evaluating the results of PPR in 97 feet with 138 plantar plate tears. Patients underwent PPR from a dorsal approach with a Weil osteotomy. We followed patients at regular intervals for 12 months and collected data preoperatively and postoperatively with respect to visual analog scale (VAS) scores, MTP range of motion (ROM), paper pull-out test, American Orthopaedic Foot & Ankle Society (AOFAS) scores, satisfaction, and radiographic measures.Results: Eighty percent of patients scored good to excellent satisfaction scores at 12 months. The mean VAS pain score preoperatively was 5.4/10, and postoperatively was 1.5/10. The mean AOFAS scores increased from 49 to 81 points following surgery. The mean MTP ROM preoperatively was 43 degrees and postoperatively 31 degrees. Forty-two percent of toes passed the paper pull out test prior to surgery and 54% at 12 months. Mean metatarsal shortening was 2.4/3.1/1.2 mm for the second, third, and fourth metatarsals, respectively. The mean MTP joint angles preoperatively were 2/4.9/-1.3 degrees and postoperatively were 7.4/9.6/0.2 degrees, respectively, for the second, third, and fourth MTP joints.Conclusion: We found that the plantar plate could be repaired through a dorsal approach with reliable outcomes. PPR was a viable option to anatomically restore the ligamentous support in the unstable lesser MTP joint. Level of Evidence: Level IV, retrospective case series.