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  

Treatment of fusion of the first metatarsophalangeal joint combined with arthroplasty of lesser metatarsal heads for elderly patients with rheumatoid forefoot

作　　者：王旭 杜斌 孙光权 WANG Xu;DU Bin;SUN Guang-quan(Department of TCM Orthopedics & Traumatology, Jiangsu Province Hospital of Chinese Medicine (Affiliate Hospital of Nanjing University of Chinese Medicine), Nanjing 210029, China)

机构地区：[1]南京中医药大学附属医院(江苏省中医院)骨伤科,江苏省南京市210029

出　　处：《实用老年医学》2021年第6期595-598,共4页Practical Geriatrics

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。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.

关 键 词：类风湿性关节炎 前足畸形 关节融合 关节成形术 

分 类 号：R682.16[医药卫生—骨科学]