第1跖趾关节融合联合跖趾关节成形术治疗老年类风湿前足畸形

doi:10.3969/j.issn.1003-9198.2021.06.015

摘要/Abstract

摘要： 目的探讨第1跖趾关节融合联合第2~5跖趾关节成形术治疗老年类风湿前足畸形的疗效。方法自2015年5月至2019年12月,采用第1跖趾关节融合联合第2~5跖趾关节成形术治疗老年类风湿前足畸形30例(48足),年龄60~77岁,平均(65.17±5.48)岁,术后定期随访,观察术前与末次随访相对应的拇外翻角(HVA)、第1~2跖骨间角(IMA)、VAS疼痛评分及美国足踝外科协会(AOFAS)前足功能评分进行疗效评价。结果全部病人术后随访成功,随访时间8~48个月,平均23个月。术后切口均为一期愈合,跖趾关节骨不愈合2足。患足术前、术后的AOFAS评分、VAS评分、HVA、IMA差异均具有统计学意义(P<0. 01)。结论第1跖趾关节融合联合第2~5跖趾关节成形术可以有效矫正老年类风湿前足畸形,缓解疼痛,恢复前足功能,且术后并发症较少。

关键词: 类风湿性关节炎, 前足畸形, 关节融合, 关节成形术

Abstract: Objective To observe the efficacy of fusion of the first metatarsophalangeal joint combined with arthroplasty of lesser metatarsal heads for elderly patients with rheumatoid forefoot. Methods From May 2015 to December 2019, 30 elderly patients (48 feet) with rheumatoid forefoot were treated by fusion of the first metatarsophalangeal joint combined with arthroplasty of lesser metatarsal heads. All the patients received regular postoperative follow-up. The clinical efficacy was evaluated by hallux valgus angle (HVA), intermetatarsal angle(IMA), visual analgue scale(VAS) and American Orthopedic Foot and Ankle society (AOFAS) scoring standard before operation and at the last follow-up. Results The final follow-up was successful in all patients, and they were followed up for 23 months on average (8~48 months). All the incisions were healed at first intention after operation, and the first metatarsophalangeal joint nonunion was found in 2 feet. The AOFAS score, HVA, IMA and VAS score were significantly improved after the treatment (P<0.01). Conclusions Fusion of the first metatarsophalangeal joint combined with arthroplasty of lesser metatarsal heads can correct the deformity of rheumatoid forefoot, relieving pain and restore forefoot function, with few postoperative complications.

Key words: rheumatoid arthritis, forefoot deformity, metatarsophalangeal joint fusion, arthroplasty

中图分类号:

R 682.16

王旭, 杜斌, 孙光权. 第1跖趾关节融合联合跖趾关节成形术治疗老年类风湿前足畸形[J]. 实用老年医学, 2021, 35(6): 595-598.

WANG Xu, DU Bin, SUN Guang-quan. Treatment of fusion of the first metatarsophalangeal joint combined with arthroplasty of lesser metatarsal heads for elderly patients with rheumatoid forefoot[J]. Practical Geriatrics, 2021, 35(6): 595-598.

参考文献

[1] SANA P C, JALEH V, SOMAYEH T. Recent approaches for targeted drug delivery in rheumatoid arthritis diagnosis and treatment[J]. Artif Cell Nanomed B, 2018, 46 (2):502-514.
[2] WHITT K J, RINCKER S A, HYER C F. Sustainability of forefoot reconstruction for the rheumatoid foot[J]. J Foot Ankle Surg, 2016, 55(3):583-585.
[3] MUELLER R B, KAEGI T, FINCKH A, et al. Is radiographic progression of late-onset rheumatoid arthritis different from young-onset rheumatoid arthritis? Results from the Swiss prospective observational cohort [J]. Rheumatology: Oxford, 2014, 53(4):671-677.
[4] JUNG S M, KWOK S K, JU J H, et al. Risk factors associated withinadequate control of disease activity in elderly patients with rheumatoid arthritis: Results from a nationwide Korean College of Rheumatology Biologics (Kobio) registry[J]. PLoS One, 2018, 13(10): e0205651.
[5] BUKHARI M, LUNT M, BARTON A, et al. Increasing age at symptom onset is associated with worse radiological damage at presentation in patients with early inflammatory polyarthritis[J]. Ann Rheum Dis, 2007, 66(3):389-393.
[6] EDENFIELD K M, MICHAUDET C, NICOLETTE G W, et al. Foot and ankle conditions: midfoot and forefoot conditions[J]. FP Essentials, 2018, 465: 30-34.
[7] COBO A R, NOGUERON G G, CALIZ R C, et al. Foot health and quality of life in patients with rheumatoid arthritis: a cross-sectional study[J]. BMJ Open, 2020, 10(5): e036903.
[8] NIEUWENHUIS W P, MANGNUS L, STEENBERGEN H W, et al. Older age is associated with more MRI-detected inflammation in hand and foot joints[J]. Rheumatology: Oxford, 2016, 55(12):2212-2219.
[9] BHAVIKATTI M, SEWELL M D, HADITHY N A, et al. Joint preserving surgery for rheumatoid forefoot deformities improves pain and corrects deformity at midterm follow-up[J]. Foot: Edinb,2012, 22(2):81-84.
[10]SHIMODA H, MOCHIDA Y, ORITSU Y, et al. Effects of forefoot arthroplasty on plantar pressure, pain, gait and disability in rheumatoid arthritis[J]. Mod Rheumatol, 2020, 30(2):301-304.
[11]HANYU T, YAMAZAKI H, ISHIKAWA H, et al. Flexible hinge toe implant arthroplasty for rheumatoid arthritis of the first metatarsophalangeal joint: long-term results[J]. J Orthop Sci, 2001, 6(2):141-147.
[12]PIERFRANCO T, FEDERICA R, ROBERTO R, et al. Fusion of the first metatarsophalangeal joint and second to fifth metatarsal head resection for rheumatoid forefoot deformity[J]. J Foot Ankle Surg, 2017, 56(2):263-270.
[13]胡东, 赵宏谋, 杨杰, 等. 手术治疗晚期类风湿性关节炎前足畸形近期疗效观察[J]. 实用骨科杂志, 2019, 25(1):77-80.
[14]陈刚, 李兵兵, 陈封明, 等. 第一跖趾关节成形术与第一跖趾关节融合术比较治疗类风湿前足畸形的Meta分析[J]. 中国循证医学杂志, 2013, 13(2):236-241.
[15]ABBEN K W, SORENSEN M D, WAVERLY B J. Immediate weightbearing after first metatarsophalangeal joint arthrodesis with screw and locking plate fixation: a short-term review[J]. J Foot Ankle Surg, 2018, 57(4):771-775.
[16]DANIEL M, JOHN K, HANBING Z, et al. A locking compression plate versus the gold-standard non-locking plate with lag screw for first metatarsophalangeal fusion: a biomechanical comparison[J]. Foot: Edinb, 2018, 34:69-73.
[17]HUNT K J, ELLINGTON J K, ANDERSON R B, et al. Locked versus nonlocked plate fixation for hallux MTP arthrodesis[J]. Foot Ankle Int, 2011, 32(7):704-709.
[18]LEWIS J T, HANSELMAN A E, DAIGRE J L, et al. Effect of dorsal plate positioning on dorsiflexion angle in arthrodesis of the first metatarsophalangeal joint: A cadaveric study[J]. Foot Ankle Int, 2014, 35(8):802-808.
[19]MOLLOY A P, MYERSON M S. Surgery of the lesser toes in rheumatoid arthritis: metatarsal head resection[J]. Foot Ankle Clin, 2007, 12(3):417-433.