ZNAČAJ MEKOTKIVNIH HIRURŠKIH INTERVENCIJA NA DISTALNOM DIJELU STOPALA U LIJEČENJU HALLUX VALGUS-A
Sažetak
Budući da su patološkoanatomske promjene na distalnim mekim tkivima prednjeg dijela stopala kod hallux valgus deformiteta degenerativne prirode i više izražene od promjena na koštanim strukturama, intervencije na ligamentarnim, kapsularnim i tetivnim strukturama su neizostavan dio hirurškog liječenja ovog deformiteta. Do sada nije utvrđen konsenzus u pogledu prirode i načina izvođenja distalnih mekotkivnih intervencija. U cilju izbjegavanja rizika od posljedične aseptične nekroze glave prve metatarzalne kosti u slučaju istovremene osteotomije na njenom distalnom nivou, potrebno je da se osteotomija izvodi na bezbjednom mjestu, kao i da plantarni i dorzalni segment ove kapsule moraju ostati sačuvani. Kako bi izbjegli pojavu jatrogenog hallux varus deformiteta, potrebno je da lateralni sezamofalangealni ligament, lateralni sezamoid kao i pripadajući dio plantarne aponeuroze ostanu sačuvani. Budući da duboki transverzalni metatarzalni ligament zadržava sezamoidni aparat u anatomskoj poziciji, njegovo oslobađanje treba izbjeći. Lateralno oslobađanje tetiva aduktora palca, lateralnog kolateralnog ligamenta i pripadajućeg dijela kapsule olakšavaju korekciju pozicije palca sa skromnim doprinosom u ukupnoj korekciji deformiteta i omogućavaju pristup skraćenom lateralnom metatarzosezamoidnom ligamentu koji se mora u potpunosti osloboditi čime se ostvaruje najveći doprinos u ukupnoj korekciji. Navedene intervencije su potpuno bezbjedne sa aspekta rizika mogućih komplikacija pogotovo kada se izvode primjenom posebnog dorzalnog intermetatarzalnog pristupa. Rekonstruktivni zahvati na mekim tkivima medijalne strane metatarzofalangealnog zgloba palca uključuju njihovo zatezanje uz stabilizaciju palca u neutralnoj poziciji.
Reference
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