| 摘要 |
FIELD: medicine.SUBSTANCE: invention refers to medicine, particularly traumatology and orthopaedics. An incision is made in a first intertarsal space, and an adductor tendon is separated and dissected away. An incision is made along an inner surface of a head of a first metatarsal bone; a capsule of a first toe of a phalanx joint is used to create a flap with its base facing distally. After an osteochondral growth is removed, a surface of the metatarsal bone is marked with planned osteotomy lines: for the first osteotomy, a lower line is drawn in parallel with an axis of the metatarsal bone at 1/4 diameters of the metatarsal bone upwards from an inferior surface of an articular cartilage, up to an inferior cortical layer of the metatarsal bone in the proximal direction from a vascular bundle of the head of the metatarsal bone; for the second osteotomy, a distal upper line starts from a superior border of the articular cartilage and further perpendicularly to the axis of the metatarsal bone up to an intersection point with the lower line; for the third osteotomy, a proximal upper line is drawn parallel with the distal upper line at approximately 5 mm. A pin is inserted into an angle formed by the distal upper and lower lines, advanced along a line connecting projections of the first and second osteotomies, and brought out through a medial cortical layer in a termination point of the 3rd osteotomy. Osteotomies are performed along the marked lines with sawing out a bone wedge with a base of 5 mm. A bonesaw-line is drawn in a metaphysis of the first metatarsal bone at 1 cm from a metatarsal wedge joint, perpendicularly to the axis of the metatarsal bone at 2/3 thicknesses of the metatarsal bone. An osteotomy area is enlarged by inclining the metatarsal bone laterally. The formed bone wedge is laid into the formed slot even with the cortical layer. The bone fragments of the distal osteotomy are aligned; the head of the metatarsal bone is displaced downwards at approximately 3-4 mm, thereby forming a lateral anterior arch of foot. The bone fragments are fixed; the hallux adductor tendon is brought under the head of the 1st metatarsal bone and sutured to the joint capsule from the medial side, closer to a back surface of the first metatarsal bone, thereby forming the lateral arch of foot. A supination is eliminated by sawing out the bone wedge from the proximal fragment of the metatarsal bone and performing external rotation of the head. The metatarsal bone is shortened by the osteotomy in parallel with the third one.EFFECT: method restores the support function of foot by normalising a lateral inclination of the articular surface of the head of the first metatarsal bone, and reduces postoperative complications.3 cl, 7 dwg, 1 ex |
