A. Erdem BAGATUR, Ahmet DOĞAN, Gazi ZORER

Metatarsus varus deformitesi ve metatarsal osteotomi ile tedavisi

Amaç: Konjenital ya da tedavi görmüş talipes ekinovarusun rezidüel deformitesi olarak görülen metatarsus varuslu hastalarda metatarsal osteotomi ile elde edilen klinik ve radyografik düzelmeyi değerlendirmek. Çalışma planı: Metatarsus varusu olan 11 hastanın (9 erkek, 2 kız) 15 ayağına düzeltici metatarsal osteotomi yapıldı. Hastaların dördünde iki taraflı, yedisinde tek taraflı tutulum vardı. Etyoloji altı hastada konjenital, beş hastada talipes ekinovarus rezidüel deformitesi idi. Ameliyat sırasında hastaların ortalama yaşı 7 yıl 1 ay (4 yıl 3 ay-11 yıl 2 ay), ortalama takip süresi 4 yıl 7 ay (1 yıl 7 ay-11 yıl 2 ay) idi. Sonuçlar: Bir hasta dışında tüm olgularda ameliyat öncesi döneme göre hem klinik hem de radyografik düzelme saptandı. Radyografik değerlendirmede, ameliyat öncesi ve sonrası 10 hastanın 13 ayağında ölçülen navikülometatarsal açı sırasıyla 132.3° (112°-142°) ve 94.6° (80°-110°) bulundu. Ameliyat öncesinde talus-birinci metatars açısının ölçüldüğü iki taraflı tutulumu olan bir olguda sağda 38° ve solda 40° olan açının ameliyattan sonra sağda 5° ve solda 0° olduğu saptandı. Değerlendirilen ayakların başinde mükemmel, sekizinde iyi, birinde orta, birinde kötü sonuç elde edildi. Bir olguda osteotomi yapılan birinci metatarsta normal tarafa göre 0.5 cm (%10) kısalık saptandı ve manyetik rezonans görüntülemesinde birinci metatars epifiz plağında hasar belirlendi. Çıkarımlar: Metatarsus varusun metatarsal osteotomi ile düzeltilmesinde, konjenital metatarsus varusta, talipes ekinovarusun rezidüel deformitesine göre daha başarılı sonuçlar alınmaktadır. Epifiz plağı düzeyinden yapılan osteotomiler ya da periostun fazla elevasyonu birinci metatarsta rezidüel bir kısalmaya yol açacağından, birinci metatarsın osteotomisi sırasında epifiz plağının ve periostun korunmasına özellikle dikkat edilmelidir.

Anahtar Kelimeler:

Çocuk, Çarpık ayak, Ayak deformitesi, edinsel, Metatarsus, Osteotomi

Metatarsus varus deformity and its treatment by metatarsal osteotomy

Objectives: To evaluate the clinical and radiographic correction obtained by metatarsal osteotomy in patients with congenital or residual metatarsus varus deformity due to previously treated talipes equinovarus. Methods: Corrective metatarsal osteotomy was performed in 15 feet of 11 patients (9 males, 2 females) with congenital (n=6) or residual (n=5) metatarsus varus deformities. The deformity was bilateral in four and unilateral in seven patients. The mean age at the time of surgery was 7 years and 1 month (range 4 years and 3 months to 11 years and 2 months), and the mean follow-up was 4 years and 7 months (range 1 year and 7 months to 11 years and 2 months). Results: All patients but one showed both clinical and radiographic improvement. On radiographic evaluation, the mean pre-and postoperative naviculometatarsal angles in 13 feet of 10 patients were 132.3$\circ$ (range 112$\circ$ to 142$\circ$) and 94.6$\circ$ (range 80$\circ$ to 110$\circ$), respectively. In one patient with bilateral involvement, the talo-first metatarsal angle was 38$\circ$ on the right and 40$\circ$ on the left preoperatively, and 5$\circ$ on the right and 0$\circ$ on the left postoperatively. The results were evaluated as excellent in five feet, good in eight feet, moderate in one foot, and poor in one foot. Shortening of 0.5 cm (10%) in the first metatarsal bone was observed in one patient and impairment of the epiphyseal plate of the first metatarsal bone was detected on magnetic resonance imaging. Conclusion: The results of metatarsal osteotomy proved to be better in patients with congenital metatarsus varus deformity compared to those with residual metatarsus varus deformity. Since shortening of the first metatarsal bone may occur if osteotomy is performed near the epiphyseal plate or with extensive periosteal stripping, attention should be paid not to injure the epiphyseal plate and the periosteum during osteotomy of the first metatarsal bone

Keywords:

Child, Clubfoot, Foot Deformities, Acquired, Metatarsus, Osteotomy,

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