| 类风湿前足畸形第5跖骨头是否切除成形的临床对比研究 |
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Received:March 24, 2023
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| 作者 | Author | 单位 | Unit | E-Mail |
| 唐润 |
TANG Run |
西安医学院, 陕西 西安 710068 |
Xi'an Medical University, Xi'an 710068, Shaanxi, China |
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| 杨杰 |
YANG Jie |
西安交通大学附属红会医院足踝外科, 陕西 西安 710054 |
Department of Foot and Ankle Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China |
yangj0611@163.com |
| 梁晓军 |
LIANG Xiao-jun |
西安交通大学附属红会医院足踝外科, 陕西 西安 710054 |
Department of Foot and Ankle Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China |
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| 李毅 |
LI Yi |
西安交通大学附属红会医院足踝外科, 陕西 西安 710054 |
Department of Foot and Ankle Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China |
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| 王军虎 |
WANG Jun-hu |
西安交通大学附属红会医院足踝外科, 陕西 西安 710054 |
Department of Foot and Ankle Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China |
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| 刘承义 |
LIU Cheng-yi |
西安医学院, 陕西 西安 710068 |
Xi'an Medical University, Xi'an 710068, Shaanxi, China |
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| 期刊信息：《中国骨伤》2024年37卷，第3期，第258-264页 |
| DOI：10.12200/j.issn.1003-0034.20220154 |
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目的:比较类风湿性关节炎(rheumatoid arthritis,RA)前足畸形重建术第5跖骨头切除成形与不切除的临床疗效。
方法:回顾性分析2015年5月至2019年1月收治的50例(76足)女性RA致前足中重度畸形患者,依据第5跖趾关节退变情况,行RA前足重建第5跖骨头保留或切除术,分为第5跖骨头保留组(保留组)和第5跖骨头切除组(切除组)。保留组24例,年龄47~81(60.37±8.60)岁;病程13~22(19.00±3.06)年;身体质量指数(body mass index,BMI)21~28(23.53±2.47) kg·m-2;中度拇外翻畸形6例(6足),重度拇外翻畸形18例(30足);采用第1跖趾关节融合联合第2-4跖趾关节成形及第5跖趾关节清理术治疗。切除组26例,年龄30~80(58.53±13.70)岁;病程8~25(17.94±3.92)年; BMI 为20~28(24.60±2.03) kg·m-2;中度拇外翻畸形4例(4足),重度拇外翻畸形22例(36足);采用第1跖趾关节融合联合2-5跖趾关节跖骨头切除成形术治疗。观察并比较两组手术时间、术后并发症情况,比较术前和末次随访时拇外翻角(hallux valgus angle,HVA),第1-2跖骨间角(intermetatarsal angles between the first and the second metatarsals,IMAFS),第1-5跖骨间角(intermetatarsal angles between the first and the fifth metatarsals,IMAFF)变化情况,并采用日本足踝外科协会(Japanese Society for Surgery of Foot,JSSF)评价临床疗效。
结果:50例均获得随访,切除组随访时间为14~46(25.30±8.83)个月;保留组随访时间为12~48(24.30±11.12)个月,两组随访时间比较,差异无统计学意义(P>0.05)。两组手术时间、术后并发症比较,差异无统计学意义(P>0.05)。切除组JSSF评分、HVA、IMAFS、IMAFF分别由术前的(45.09±3.35)分、(38.90±13.67)°、(12.88±1.72)°、(32.50±2.99)°改善至末次随访时的(81.60±3.27)分、(15.40±0.96)°、(9.06±2.27)°、(22.20±1.98)°(P<0.05);保留组分别由(47.09±3.96)分、(43.30±12.65)°、(13.99±3.13)°、(33.20±6.14)°改善至(83.10±3.66)分、(15.20±1.54)°、(8.99±1.02)°、(24.70±1.88)°。两组间术前及末次随访时JSSF评分、HVA、IMAFS、IMAFF比较,差异均无统计学意义(P>0.05)。末次随访时,两组 JSSF评分中疼痛、畸形比较,差异有统计学意义(P<0.05)。
结论:无论是类风湿前足重建术还是前足重建第5跖趾关节清理术,术后临床疗效及影像学结果均明显改善。对比类风湿前足重建术,类风湿前足重建第5跖趾关节清理术治疗类风湿前足中重度畸形,疼痛改善明显,但畸形改善较差。对于类风湿引起的前足中重度畸形,第5跖趾头关节面轻中度退变畸形的患者可考虑使用。 |
| [关键词]:类风湿关节炎 前足畸形 关节融合 关节成形术 |
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| Clinical comparative study on resection and non-resection of the fifth metatarsal to rheumatoid forefoot deformity |
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Abstract:
Objective To explore clinical effect of the fifth metatarsal head excision and non-excision in rheumatoid arthritis (RA) forefoot deformity reconstruction.
Methods Retrospective analysis was performed on 50 patients (76 feet) with moderate to severe forefoot deformity caused by RA treated from May 2015 to January 2019. According to degeneration of the fifth metatarsophalangeal joint,the fifth metatarsal head was retained or excised by wind-like forefoot reconstruction,and divided into the fifth metatarsal head preservation group (preservation group) and the fifth metatarsal head resection group (resection group). Twenty-four female patients in preservation group,aged from 47 to 81 years old with an average of (60.37±8.60) years old;the course of disease ranged from 13 to 22 years with an average of (19.00±3.06) years;body mass index (BMI) ranged from 21 to 28 kg·m-2 with an average of (23.53±2.47) kg·m-2;six patients (6 feet) with moderate hallux valgus deformity and 18 patients (30 feet) with severe hallux valgus deformity;treated with the first metatarsophalangeal joint fusion combined with the second th the fourth metatarsophalangeal joint arthroplasty and the fifth metatarsophalangeal joint cleanup. Twenty-six female patients in resection group were female,aged from 30 to 80 years old with an average of (58.53±13.70) years old;the course of disease ranged from 8 to 25 years with an average of (17.94±3.92) years;BMI raged from 20 to 28 kg·m-2 with an average of (24.60±2.03) kg·m-2;4 patients (4 feet) with moderate bunion valgus deformity and 22 patients (36 feet) with severe bunion valgus deformity;treated by the first metatarsophalangeal joint fusion combined with the second th the fifth metatarsophalangeal joint resection of the metatarsophalangeal head. Operation time and postoperative complications between two groups were observed,hallux valgus angle (HVA),intermetatarsal angles between the first and the second metatarsals (IMAFS),intermetatarsal angles between the first and fifth metatarsals (IMAFF),Japanese Society for Surgery of Foot (JSSF) score before surgery and at the latest follow-up were compared.
Results Fifty patients were followed-up from 14 to 46(25.30±8.83) months in resection group and 12 to 48 with an average of (24.30±11.12) months in preservation group,while no significant difference between two groups (P>0.05). There were no significant difference in operation time and postoperative complications between two groups (P>0.05). JSSF scores,HVA,IMAFS and IMAFF in fesection group were improved from (45.09±3.35) points,(38.90±13.67)°,(12.88±1.72)°,(32.50±2.99)° before operation to (81.60±3.27) points,(15.40±0.90),(9.06±2.27)°,(22.20±1.98)° at the latest follow-up (P<0.05);preservation group were improved from (47.09±3.96) points,(43.30±12.65)°,(13.99±3.13)°,(33.20±6.14)° to (83.10±3.66) points,(15.20±1.54)°,(8.99±1.02)°,(24.70±1.88)°,respectively. There were no significant difference in JSSF score,HVA,IMAFS and IMAFF between two groups before operation and the latest follow-up (P>0.05). At the latest follow-up,there were statistically significant differences in pain and deformity in JSSF scores between two groups (P<0.05).
Conclusion Both rheumatoid anterior foot reconstruction and anterior foot reconstruction fifth metatarsophalangeal joint debridement showed significant improvement in clinical efficacy and imaging results. Compared with rheumatoid prefoot reconstruction,the fifth metatarsophalangeal joint reconstruction for the treatment of moderate and severe deformity of rheumatoid prefoot showed better improvement in pain,but worse improvement in deformity. For the moderate to severe deformity of the forefoot caused by rheumatoid disease,patients with mild to moderate degenerative deformity of the articular surface of the fifth metatarsal phalanges may be considered for use. |
| KEYWORDS:Rheumatoid Arthritis Forefoot deformity Joint fusion Joint arthroplasty |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 唐润,杨杰,梁晓军,李毅,王军虎,刘承义.类风湿前足畸形第5跖骨头是否切除成形的临床对比研究[J].中国骨伤,2024,37(3):258~264 |
| 英文格式: | TANG Run,YANG Jie,LIANG Xiao-jun,LI Yi,WANG Jun-hu,LIU Cheng-yi.Clinical comparative study on resection and non-resection of the fifth metatarsal to rheumatoid forefoot deformity[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(3):258~264 |
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