CAJ | 학술논문

目的探讨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关节炎致前足畸形的效果.方法回顾性分析2007年6月至2010年10月采用第一跖趾关节融合联合二至五跖趾关节成形治疗19例(35足)类风湿关节炎致前足畸形患者资料,男2例(4足),女17例(31足)；年龄33～73岁,平均56岁.患者均有不同程度(足母)外翻锤状趾畸形和跖痛.采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)(足母)趾、跖趾、趾间关节评分及视觉模拟(visual analogue scale,VAS)评分评价手术效果.在术前及术后X线片上测量(足母)外翻角(hallux valgus angle,HVA)及第一、二跖骨间角(intermetatarsal angle,IMA),了解畸形矫正情况.结果术后17例(32足)患者获得平均42个月随访,患足外形均得到不同程度改善；29足跖痛完全消失；3足出现第五跖骨外侧转移性跖痛,经垫前足减压垫缓解.1足因(足母)趾末节部分坏死而切除.成形的跖趾关节均有不同程度僵硬.AOFAS评分、VAS评分、HVA及IMA度数,术前分别为(46.82±6.13)分、(9.03±1.82)分、38.96°±10.13°、15.87°±3.43°,末次随访时为(84.25±2.87)分、(2.12±0.67)分、15.84°±5.12°、10.35°±1.67°.根据AOFAS评分,优23足,良5足,可4足,优良率为87.5％ (28/32).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关节炎致前足畸形效果优良,术后能明显矫正畸形,缓解疼痛,改善功能.
목적 탐토채용제일척지관절융합연합이지오척지관절성형치료류풍습관절염치전족기형적효과.방법 회고성분석2007년6월지2010년10월채용제일척지관절융합연합이지오척지관절성형치료19례(35족)류풍습관절염치전족기형환자자료,남2례(4족),녀17례(31족)；년령33～73세,평균56세.환자균유불동정도(족모)외번추상지기형화척통.채용미국족과외과협회(American Orthopaedic Foot and Ankle Society,AOFAS)(족모)지、척지、지간관절평분급시각모의(visual analogue scale,VAS)평분평개수술효과.재술전급술후X선편상측량(족모)외번각(hallux valgus angle,HVA)급제일、이척 골간각(intermetatarsal angle,IMA),료해기형교정정황.결과 술후17례(32족)환자획득평균42개월수방,환족외형균득도불동정도개선；29족척통완전소실；3족출현제오척골외측전이성척통,경점전족감압점완해.1족인(족모)지말절부분배사이절제.성형적척지관절균유불동정도강경.AOFAS평분、VAS평분、HVA급IMA도수,술전분별위(46.82±6.13)분、(9.03±1.82)분、38.96°±10.13°、15.87°±3.43°,말차수방시위(84.25±2.87)분、(2.12±0.67)분、15.84°±5.12°、10.35°±1.67°.근거AOFAS평분,우23족,량5족,가4족,우량솔위87.5％ (28/32).결론 제일척지관절융합연합이지오척지관절성형치료류풍습관절염치전족기형효과우량,술후능명현교정기형,완해동통,개선공능.
Objective To explore the effect of the treatment of forefoot deformities caused by rheumatoid arthritis by the method of the first metatarsophalangeal joint fusion combined with metatarsophalangeal arthroplasty from the second to the fifth toe.Methods The data of 19 patients with forefoot deformities caused by rheumatoid arthritis was retrospectively studied after receiving the treatment by the method of the first metatarsophalangeal joint fusion combined with metatarsophalangeal arthroplasty from the second to the fifth toe from June 2007 to October 2010.There were 17 females (31 feet) and 2 males (4 feet) with an average age of 56 years (range,33-73 years).The American Orthopaedic Foot and Ankle Society (AOFAS),visual analogue scale (VAS) were applied.Hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured to investigate the changes in forefoot deformity preoperatively and postoperatively respectively.Results In 17 cases,the appearances of forefoot were improved in different degrees.The metatarsalgia disappeared completely in 29 feet.In other 3 feet,the fifth metatarsal metastatic metatarsalgia appeared and the pain was relieved after the forefoot decompression pad treatment.The distal end of hallux was excised due to necrosis.Forming joint have different degrees of anchylosis.The AOFAS improved from 46.82±6.13 preoperative to 84.25±2.87 postoperative,while the VAS,HVA,IMA decreased from 9.03±1.82,38.96°±10.13° and 15.87°±3.43° to 2.12±0.67,15.84°±5.12° and 10.35°±1.67° respectively.Conclusion The effect of the treatment for forefoot deformities caused by rheumatoid arthritis by the first metatarsophalangeal joint fusion combined with metatarsophalangeal arthroplasty from the second to the fifth toe is excellent.