Lesser Metatarsophalangeal Joint Instability: Prospective Evaluation and Repair of Plantar Plate and Capsular Insufficiency
Lesser Metatarsophalangeal Joint Instability: Prospective Evaluation and Repair of Plantar Plate and Capsular Insufficiency
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DOI：
10.3113/fai.2012.0301
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发表时间：
2012-04-01
影响因子：
2.7
通讯作者：
Mann, Tania S.
中科院分区：
文献类型：
--
作者：
Nery, Caio;Coughlin, Michael J.;Mann, Tania S.
背景资料：对第二跖趾关节的解剖学研究表明，由于跖板位于关节中央并有多个重要附件，因此跖板是关节的主要稳定结构。当保守治疗失败时，许多外科手术都被推荐，但有些手术的临床成功率有限。我们的前瞻性研究的目的是显示通过背侧入路直接修复结合Weil跖骨截骨术治疗一组足底板撕裂患者的结果，至少随访12个月。研究方法：我们前瞻性治疗了28例（55个MTP关节）较小NUT关节不稳定的患者，但只有22例（40个MTP关节）通过足底板直接修复进行了治疗，并被纳入研究。所有患者最初主诉急性前足疼痛，随后出现MTP关节畸形和不稳定。所有患者均接受临床、影像学（平片和MRI检查）和MTP关节镜检查。结果：第二MTP关节的足底部位是最常见的受累关节（63%），Ⅲ级撕裂（横向和/或纵向延伸撕裂）是最常见的类型。通过手术治疗，我们能够显著改善所研究的参数（疼痛、脚趾内侧或背内侧偏斜、关节稳定性、肌肉平衡和关节一致性）至可接受的水平。AOFAS评分从术前平均52分显著改善至术后92分。结论：直接修复跖板结合Weil截骨和外侧软组织紧缩可以恢复MTP关节的正常对线。我们已经证明，跖板的解剖修复可以纠正受影响的脚趾（内侧，背侧，背内侧或背外侧）的偏差，从而减少疼痛，改善功能评分。
Background: Anatomical dissection of the second metatarsophalangeal (MTP) joint suggests that the plantar plate is the major stabilizing structure of the joint due to its central location and multiple important attachments. Many surgical procedures have been recommended when conservative treatment has failed, but some have had limited clinical success. The aim of Our prospective study was to show the results obtained in the treatment of a group of patients with plantar plate tears by direct repair through a dorsal approach combined with a Weil metatarsal osteotomy with a minimum followup of 12 months. Methods: We prospectively treated 28 patients (55 MTP joints) with lesser NUT joint instability, but only 22 patients (40 MTP joints) were treated by the direct repair of the plantar plate and were included in the study. All of them had initial complaints of acute forefoot pain with the subsequent development of deformity and instability of the MTP joints. All patients were evaluated clinically, radiographically, (plain radiographs and MRI exam), and by MTP joint arthroscopy. With this data, a direct correlation between the clinical staging and the anatomical grading for plantar plate dysfunction of each patient was determined Results: The plantar place of the second MTP joint was the most commonly affected joint (63%), and Grade III type tear (transverse and/or longitudinal extension tear) was the most frequent type. With the surgical treatment, we were able to markedly improve the parameters studied (pain, medial or dorsomedial deviation of the toe, joint stability, muscle balance, and joint congruence) to acceptable levels, The AOFAS score improved substantially from an average of 52 points preoperatively to 92 points postoperatively. Conclusion: The direct plantar plate repair combined with a Weil osteotomy and lateral soft tissue reefing can restore the normal alignment of the MTP joint. We have demonstrated that the anatomic repair of the plantar plate can correct the deviation of the affected toe (medial, dorsal, dorsomedial or dorsolateral), which lead to diminished pain with improved functional scores.