结构性植骨融合治疗第一跖趾关节严重痛风性关节炎7例  

7 Cases of Treatment of First Metatarsophalangeal Joint Gouty Arthritis by Arthrodesis with Structural Bone Graft

作　　者：邱元洲 高彦军 阮培灿 何昌强 刘弋祥 李炜峰 张鹂明 冯敏山[3] QIU Yuanzhou;GAO Yanjun;RUAN Peican;HE changqiang;LIU Yixiang;LI Weifeng;ZHANG Liming;FENG Minshan(Shenzhen Luohu Traditional Chinese Medicine Hospital,,Shenzhen 518000,Guangdong China;Shenzhen Luohu Guiyuan Sub-District Community Health Service Center,Shenzhen 518000,Guangdong China;Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]深圳市罗湖区中医院,广东深圳518000 [2]深圳市罗湖区桂园街道社区健康服务中心 [3]中国中医科学院望京医院

出　　处：《中国中医骨伤科杂志》2025年第3期64-67,共4页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨采用病灶切除结合结构性植骨关节融合治疗第一跖趾关节严重痛风性关节炎的治疗方法及临床疗效。方法:从2019年1月至2023年6月共收治7例第一跖趾关节严重痛风性关节炎患者,均为男性,年龄为41~69岁,平均为52.3岁。所有患者均采用病灶切除结合结构性植骨第一跖趾关节融合术,术后观察患者伤口愈合情况,定期复查X线片明确骨愈合情况,并采用疼痛视觉模拟量表(VAS)评分及美国骨科足踝外科协会(AOFAS)前足评分评价治疗效果,观察并记录相关并发症。结果:2例患者伤口延迟愈合,经过换药后渐愈合;1例患者伤口不愈合,经过清创+皮瓣成形术后伤口愈合;其余患者伤口均一期愈合。术后7例患者获得12~24个月随访,平均随访18个月。X线片检查平均术后13.6周融合端骨性愈合。VAS评分从术前(6.0±1.0)分降至末次随访(1.5±0.5)分,AOFAS评分从术前(44.4±6.5)分提高至末次随访(88.0±6.8)分,差异均有统计学意义(P<0.001)。随访期间未见骨不连、畸形愈合及固定失效等并发症。结论:病灶切除结合结构性植骨融合治疗第一跖趾关节严重痛风性关节炎存在一定伤口愈合风险,但患者症状可明显缓解,术后融合端融合率较高,明显改善患者生活质量,是一种有效的治疗方法。Objective:To investigate the technique and clinical outcome of arthrodesis with resection and structural bone graft for the treatment of the first metatarsophalangeal joint gouty arthritis.Methods:Seven patients suffering from first metatarsophalangeal joint gouty arthritis were treated from January 2019 to June 2023.There were 7 men with an average age of 52.3 years old(range 41-69 years old).The first metatarsophalangeal joint arthritis with structural bone graft was performed in all patients.X-rays were taken in regular follow-up to confirm fusion.Overall functional evaluation was carried out according to the visual analogue scale(VAS) and the forefoot score of American Orthopaedic Foot and Ankle Society(AOFAS) at the last follow-up.Complications were also recorded.Results:2 patients exhibited delayed wound healing that resolved with dressing changes.1 patient had a wound that did not initially heal,which subsequently united after debridement and flap plasty.7 patients got the final follow-up of an average 18 months(range,12-24 months).X-ray demonstrated the bone union of fusion 13.5 weeks postoperatively on average.VAS score was decreased from(6.0±1.0) points to(1.5±0.5) points.AOFAS score was improved from(44.4±6.5) points preoperatively to(88.0±6.8) points postoperatively.There were significant differences in AOFAS scores and VAS scores before and after surgery(P<0.001).No complications,such as non-union,malunion or implant failure occurred during follow-up.Conclusion:Arthrodesis with structural bone graft,despite certain wound healing risks,can effectively relieve pain,achieve high fusion rate,and improve quality of patients' life for the treatment of the first metatarsophalangeal joint gouty arthritis.It is an effective therapeutic procedure.

关 键 词：病灶切除 结构性植骨 融合术 第一跖趾关节 痛风性关节炎 

分 类 号：R684.3[医药卫生—骨科学]