Swanson人工跖趾关节置换术治疗晚期跖骨头骨软骨病  

Swanson double-stem silicone implant arthroplasty in the treatment of late-stage osteochondrosis of metatarsal head

作　　者：陈兆军[1] 王正义[1] 吴俊德[1] 马显志[1] 马占华[1] 

机构地区：[1]北京中医药大学第三附属医院手足骨科,北京100029

出　　处：《中国骨与关节外科》2012年第4期325-328,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:第二跖骨头骨软骨病的基本病理改变是跖骨头关节软骨和髓软骨内骨化障碍。对中晚期患者,大部分学者主张早期手术干预。而目前采用的手术方法多种多样,且各有利弊。目的:观察Swanson人工跖趾关节置换术治疗晚期跖骨头骨软骨病的疗效。方法:2007年5月至2011年3月,利用Swanson人工跖趾关节置换治疗且有完整随访资料的晚期跖骨头骨软骨病患者19例(36足),男7例(14足),女12例(22足);年龄43～76岁,平均57.8岁。单侧2例,双侧17例;病变于第二跖趾关节16例,第三跖趾关节3例;合并外翻畸形13例,趾间神经瘤2例。负重位X线片参照Smillie分期:Ⅲ期1例,Ⅳ期11例,Ⅴ期7例。测量并记录术前、术后跖趾关节背伸、跖屈角度。结果:随访时间最长5年,最短14个月,平均3.6年。术后患者跖趾关节处疼痛消失,活动自如,术前跖趾关节活动度:背伸10.6°±2.87°,跖屈18.3°±1.96°;术后:背伸32.9°±1.67°,跖屈36.7°±1.17°,术后与术前关节活动度比较,差异有统计学意义(P<0.05)。根据美国足踝外科协会Maryland跖趾关节百分评分法对本组患者进行评定,优为90～100分,26足,占72.2%;良为80～89分,足,占22.2%;可为70～79分,足,占5.6%。优良率为94.4%。82结论:对于年龄较大且处于Smillie分期晚期的跖骨头骨软骨病患者,Swanson人工跖趾关节置换术是一个较好的治疗方法。Background： The basic pathological change of the second metatarsal head osteochondrosis is ossification obstacles of the cartilage in metatarsophalangeal joint （MPJ） and marrow. Most experts advocate surgical intervention for the late-stage pa- tients. There are many treatments for the disease and all the surgical methods have their advantages and disadvantages. Objective： The aim of the study is to observe the curative effect of Swanson double-stem silicone implant arthroplasty in the treatment of advanced-stage osteochondrosis of metatarsal head. Methods： From May 2007 to March 2011, Swanson double-stem silicone implant arthroplasty was performed in 19 patients （36 feet） with advanced-stage osteoehondrosis of metatarsal head. There were 7 males （14 feet） and 12 females （22 feet） aged from 43 to 76 years （mean, 57.8 years）. Complete follow-up data of all the patients were obtained. Unilateral injury oc- curred in 2 patients and bilateral injuries in 17 patients. The lesions affected the second MPJ in 16 pattients and the third MPJ in 3 patients. There were 13 cases with hallux valgus and 2 cases with Morton＇s neuromas. According to the Smillie classification, there were 1 case with grade III osteonecrosis, 11 cases with grade IV, and 7 cases with grade V. Range of motion of MPJ was measured before and after the operation. Results： All the patients were followed up for an average duration of 3.6 years （14 months to 5 years）. The MPJ pain disap- peared and the joints could move freely after the operation. Postoperative dorsal flexion angle and plantar flexion angle were significantly increased as compared with the preoperative ones （32.9°±1.67° vs 10.6°±2.87°36.7°±1.17° vs 18.3°±1.96°, P〈0.05）. And the Maryland scoring system of the AOFAS was used for clinical assessment. A score of 90 to 100 points was considered excellent （26 feet, accounts for 72.2%）, 80 to 89 points was good （8 feet, accounts for 22.2%）, 70 to 79 points was fair （2 feet, accounts fo

关 键 词：跖趾关节 置换 跖骨 假体 

分 类 号：R687.3[医药卫生—骨科学]