第一跖趾关节融合联合第二至五跖趾关节成形治疗类风湿前足畸形的疗效观察  

Effect of combined treatment of the first metatarsophalangeal joint fusion with the second to fifth metatarsophalangeal arthroplastyon rheumatoid forefoot deformity

作　　者：及松洁[1] 黄野[1] 唐竞[1] 杜辉[1] 邵宏翊[1] 姜旭[1] 周一新[1] JI Song-jie;HUANG Ye;TANG Jing;DU Hui;SHAO Hong-yi;JIANG Xu;ZHOU Yi-xin(Department of Adult Joint Reconstruction Surgery,Beijing Jishuitan Hospital,Beijing 100035, China)

机构地区：[1]北京积水潭医院矫形骨科,北京100035

出　　处：《基础医学与临床》2021年第10期1486-1490,共5页Basic and Clinical Medicine

基　　金：北京积水潭医院青年人才培养学科新星计划项目(XKXX2018)。

摘　　要：目的分析采用第一跖趾关节融合联合二至五跖趾关节成形治疗类风湿前足畸形的效果。方法选取2015年1月至2019年12月治疗的类风湿前足畸形21例(36足)的患者资料,均采用第一跖趾关节融合联合二至五跖趾关节成形进行治疗。患者均为女性;年龄(58~75)岁,平均(63.6±6.0)岁。采用美国足踝外科协会(A0FAS)拇指-跖趾关节评分及视觉模拟(VAS)评分评价手术效果。分别测量术前和末次随访时足负重位的拇外翻角(HVA)和第一、二跖骨间角(IMA)。结果21例(36足)平均随访(39.2±5.1)个月,无不愈合,切口感染,足趾坏死等并发症。A0FAS评分、VAS评分、HVA及IMA度数,术前分别为(81.6±9.1)分、(8.4+1.1)分、37.2°±7.5°、16.9°±2.7°,末次随访时为(84.25±2.87)分、(1.9±0.9)分、14.4°±2.0°、11.1°±1.7°。改善均有统计学意义(P<0.05)。根据A0FAS评分,优7足,良23足,可6足,优良率为83.3%(30/36)。结论第一跖趾关节融合联合二至五跖趾关节成形治疗类风湿前足畸形效果肯定,能矫正畸形,缓解疼痛,改善功能。Objective To analyze the effect of the first metatarsophalangeal joint fusion combined with 2-5 metatarsophalangeal arthroplasty in the treatment of rheumatoid foot deformity.Methods From January 2015 to December 2019,21 patients(36 feet)who have rheumatoid anterior foot deformity,with an average age of 63.6±6.0 years,were performed first metatarsophalangeal joint fusion and 2-5 metatarsophalangeal arthroplasty.The results of the operation were evaluated by the American Orthopaedic Foot and Ankle Society(AOFAS)scores and visual analog scale(VAS).The hallux valgus angle(HVA)and the intermetatarsal angle(IMA)were measured on the X-ray pre-operative and post-operative films.Results The follow-up period of 21 cases(36 feet)was 39.2±5.1 months,without any complication.The preoperative and postoperative scores of AOFAS,VAS,HVA and IMA were 81.6±9.1,8.4±1.1,37.2°±7.5°,16.9°±2.7°,and 84.25±2.87,1.9±0.9,14.4°±2.0°,11.1°±1.7°respectively.The improvement was statistically significant(P<0.05).Conclusions The first metatarsophalangeal joint fusion combined with 2-5 metatarsophalangeal arthroplasty was effective on rheumatoid forefoot deformity,which can correct the deformity,relieve pain and improve the function.

关 键 词：类风湿性关节炎 类风湿足 足畸形 结果 关节融合 

分 类 号：R684.3[医药卫生—骨科学]