两种手术方式治疗晚期足母僵硬的短期疗效分析  

Short-term Outcomes of Two Surgical Method in the Treatment of End-stage Hallux Rigidus

作　　者：屈福锋 姬维娜 曾秋[2] 梁晓军[2] Qu Fufeng;Ji Weina;Zeng Qiu(Xi’an Medical University,Xi’an 710068,China;Xi’an Honghui Hospital,Xi’an 710054,China)

机构地区：[1]西安医学院,陕西西安710068 [2]西安交通大学附属红会医院,陕西西安710054

出　　处：《实用骨科杂志》2019年第4期317-320,325,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨第1跖趾关节置换术与第1跖趾关节融合术治疗晚期足母僵硬的短期疗效。方法 2015年2月至2016年8月行第1跖趾关节融合术或置换术治疗的晚期足母僵硬患者共27例(27足)符合纳入标准,年龄28～52岁,平均年龄(39.0±3.6)岁。其中关节融合组12例,男2例,女10例,年龄30～52岁,平均年龄(40.0±2.5)岁;关节置换组15例,男5例,女10例,年龄28～52岁,平均年龄(39.0±3.4)岁。采用末次随访及术前第1跖趾关节活动度(range of motion,ROM)、Maryland评分、疼痛模拟视觉评分(visual analogue scale,VAS)进行疗效分析。结果所有患者均获得随访,随访11～17个月,平均随访(14.0±2.7)个月,两组平均随访时间差异无统计学意义(P>0.05)。关节融合组:末次随访时平均Maryland评分提高了15.3分,平均VAS评分降低了4.4分,差异均具有统计学意义(P<0.05),融合组术后丧失关节活动度。所有融合组患者末次随访时融合均已愈合,4例患者出现转移性跖疼痛,予以矫形鞋垫治疗后疼痛基本消失。关节置换组:末次随访时平均Maryland评分提高20.2分、平均VAS评分降低4.6分、平均ROM提高40.1°,差异均具有统计学意义(P<0.05)。所有关节置换组患者末次随访时无假体不良事件发生,1例患者术后伤口皮缘坏死,多次换药后伤口获得愈合。组间比较:两组术前平均ROM、平均VAS评分、平均Maryland评分差异无统计学意义(P>0.05);末次随访时关节置换组平均Maryland评分较关节融合组高,差异有统计学意义(P<0.05);末次随访时两组平均VAS评分差异无统计学意义(P>0.05);末次随访时关节融合组无ROM,两组无法进行组间统计学比较。结论第1跖趾关节置换术与第1跖趾关节融合术治疗晚期足母僵硬短期疗效满意,且第1跖趾关节置换的疗效更佳,但是两者中长期疗效有待进一步随访。Objective To evaluate the short-term outcomes of the first metatarsophalangeal joint replacement and the first metatarsophalangeal joint fusion in the treatment of end-stage hallux rigidus.Methods From February 2015 to August 2016,27 patients(27 feet)were diagnosed with end-stage hallux rigidus and eligible to research standard.They were treated by the first metatarsophalangeal joint replacement or fusion,and their age ranged from 28 to 52 years old with an average age of(39.0±3.6)years old.Among them,the joint fusion group had 2 males and 10 females,and their age ranged from 30 to 52 years old,with an average age of(40.0±2.5)years old.Joint replacement group were consisted of 5 males and 10 females,and their age ranged from 28 to 52 years old with an average age of(39.0±3.4)years old.The outcomes were analyzed by the range of motion(ROM)of first metatarsophalangeal joint,Maryland score,and Visual Analogue Score(VAS)of the last follow-up and preoperation.Results All the patients were effectively followed up,and their follow-up times were 11 to 17 months with the average follow-up time of(14.0±2.7)months.There were no significant differences in follow-up time between the two groups(P<0.05).In joint fusion group,the average Maryland scores were increased by 15.3 points and the average VAS scores were decreased by 4.4 points in the final follow-up,and the differences were statistically significant(P<0.05).The joint range of motion were lost in the fusion group after the operation.All the patients in the fusion group obtained the fusion at the end of follow-up,and 4 patients had metatarsalgia and the pain was nearly disappeared after treatment by orthopaedic insoles.In joint replacement group,the average Maryland scores were increased by 20.2 points,the average VAS scores were decreased by 4.6 points,and the average ROM was increased by 40.1°in the last follow-up,and the difference were statistically significant(P<0.05).All patients in the joint replacement group,there were no prosthesis adverse events in the la

关 键 词：僵硬 关节置换 关节融合 

分 类 号：R682.16[医药卫生—骨科学]