Одномоментная коррекция врожденной брахиметатарзии у подростков и пациентов молодого возраста

Introduction. Brachymetatarsia is a relatively rare abnormal shortening of metatarsal bone with female predominance. No consensus exists about the ideal surgical treatment for this condition while the two common strategies are gradual lengthening using external fixation and acute one stage lengthening. We describe the surgical technique of acute lengthening using iliac bone graft and report our results. Materials and Methods. Twelve patients (11 females, one male) with 14 short metatarsals were treated in our hospital over a 12-year period. The mean age was 17.4 years (range 14-28 years). Treatment protocol included metatarsal osteotomy, lengthening of extensor tendon and percutaneous tenotomy of the flexor tendon at the level of affected MP joint. Autologous iliac bone graft was inserted after elongation of the metatarsal by distraction through the osteotomy site and fixed using Kirshner wire. Results. Average metatarsal shortening was 13mm (range, 11-18 mm). The metatarsal length gained was an average of 12mm (range, 11-15 mm). Uneventful bone union was achieved in all cases after six weeks. At the end of treatment, the normal cascade of the metatarsal heads (metatarsal parabola) had been restored in 11 of the 14 metatarsals treated. There were no wound complications or pin tract infections around the wire. All but one patient were satisfied with the cosmetic appearance of the foot. Conclusion. Based on our experience, acute metatarsal lengthening using an iliac autugraft is a reliable and effective treatment method for congenital brachymetatarsia in adolescents and young adults.Level of Evidence: Level IV Case series.Введение. Брахиметатарзия является относительно редкой патологией аномального укорочения плюсневых костей, наиболее часто встречающейся у женщин. В настоящее время отсутствует консенсус в отношении идеального хирургического метода лечения данной деформации, и существуют две общепризнанные стратегии лечения: постепенное удлинение с использованием чрескостного остеосинтеза и одномоментное удлинение с применением аутотрансплантата. Авторы описывают хирургическую технику и приводят свои результаты выполнения одномоментной процедуры удлинения с использованием аутотрансплантата из гребня подвздошной кости. Материал и методы. За 12-летний период в клинике были прооперированы 12 пациентов (11 женщин, 1 мужчина) с укорочениями 14 плюсневых костей. Средний возраст пациентов — 17,4 лет (от 14 до 28 лет). Протокол лечения включал остеотомию плюсневых костей, удлинение сухожилия разгибателя и чрезкожную тенотомию сухожилия сгибателя на уровне деформированного пястно-фалангового сустава. Аутотрансплантат из гребня подвздошной кости помещали в область остеотомии после дистракции плюсневой кости и фиксировали спицами Киршнера. Результаты. Средняя величина укорочения плюсневых костей составляла 13 мм (в диапазоне от 11 до 18 мм). Средняя величина достигнутого удлинения составила 12 мм (в диапазоне от 11 до 15 мм). Костное сращение без осложнений у всех пациентов наблюдали через шесть недель. В результате лечения было восстановлено нормальное анатомическое соотношение головок плюсневых костей (плюсневая парабола) у 11 из 14 плюсневых костей. Авторы не наблюдали случаев осложнения заживления хирургической раны или инфекции в области введения спиц. За исключением одного все пациенты были удовлетворены эстетическим внешним видом стопы. Заключение. Исходя из опыта авторов, одноэтапное удлинение плюсневых костей с применением аутотрансплантата из подвздошной кости является надежным и эффективным методом лечения врожденной брахиметатарзии у подростков и пациентов молодого возраста. Уровень доказательности: IV, серия клинических наблюдений

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