類風濕性關節炎前足畸形重建手術的近期療效_《中國修復重建外科雜志》

作者：

段小軍 , 楊柳 , 戴剛 , 彭旭

第三軍醫大學西南醫院關節外科中心（重慶，400038）;

關鍵詞：

類風濕性關節炎前足畸形關節融合截骨手術重建手術

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的探討類風濕性關節炎前足畸形的手術治療方法及近期療效。方法 2007 年1 月－ 2009 年8 月，采用第1 跖趾關節融合術聯合第2 ～ 5 跖趾關節成形術治療7 例類風濕性關節炎前足畸形女性患者。年齡56 ～ 71 歲，平均62 歲。病程5 ～ 30 年，平均16 年。患者均表現為雙足外翻，第2 ～ 5 趾合并錘狀趾或槌狀趾畸形，其中5 足合并第2 跖趾關節半脫位。根據美國矯形足踝協會（AOFAS）改良標準評分為（36.9 ± 6.4）分。術前負重位X 線片測量，第1跖趾關節外翻角度（46 ± 5）°，第1、2 跖骨間夾角（12 ± 2）°。結果術后切口均Ⅰ期愈合。術后3 ～ 4 個月X 線片復查示第1 跖趾關節達骨性融合。7 例均獲隨訪，隨訪時間2 ～ 4 年，平均2.9 年。患者跛行步態均較術前明顯改善，行走時足部疼痛明顯緩解。術后3 個月X 線片測量第1 跖趾關節外翻角度為（17 ± 4）°，第1、2 跖骨間夾角為（11 ± 2）°，0與術前比較差異均有統計學意義（P lt; 0.05）。術后2 年根據AOFAS 改良標準評分為（85.3 ± 5.1）分，與術前比較差異有統計學意義（t=4.501，P=0.001）。1 例于術后4 年前足轉移性跖骨痛復發，繼續隨訪中未作特殊處理。結論第1 跖趾關節融合術聯合第2 ～ 5 跖趾關節成形術治療類風濕性關節炎前足畸形，可獲得較好外翻矯形，重塑前足負重面，有效緩解行走時疼痛。

引用本文： 段小軍,楊柳,戴剛,彭旭. 類風濕性關節炎前足畸形重建手術的近期療效. 中國修復重建外科雜志, 2012, 26(4): 445-448. doi: 復制

1.	過邦輔. 類風濕性關節炎 (十) ——踝關節與足類風濕性關節炎的外科治療. 中華骨科雜志, 1998, 18(10): 637-640.
2.	Fishman SA. Rheumatoid arthritis with forefoot reconstruction. J Foot Surg, 1989, 28(3): 204-207.
3.	Amin A, Cullen N, Singh D. Rheumatoid forefoot reconstruction. Acta Orthop Belg, 2010, 76(3): 289-297.
4.	McKinley JC, Shortt N, Arthur C, et al. Outcomes following pantalar arthrodesis in rheumatoid arthritis. Foot Ankle Int, 2011, 32(7): 681-685.
5.	Coughlin MJ, Mann RA. Hallux valgus//Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. 8th ed. St. Louis: Mosby, 2006: 184-354.
6.	Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum, 1988, 31(3): 315-324.
7.	Bolland BJ, Sauvé PS, Taylor GR. Rheumatoid forefoot reconstruction: first metatarsophalangeal joint fusion combined with Weil’s metatarsal osteotomies of the lesser rays. J Foot Ankle Surg, 2008, 47(2): 80-88.
8.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
9.	McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med, 2011, 365(23): 2205-2219.
10.	Doorn PF, Keijsers NL, van Limbeek J, et al. A clinical classification system for rheumatoid forefoot deformity. Foot Ankle Surg, 2011, 17(3): 158-165.
11.	van Tuyl LH, Britsemmer K, Wells GA, et al. Remission in early rheumatoid arthritis defined by 28 joint counts: limited consequences of residual disease activity in the forefeet on outcome. Ann Rheum Dis, 2012, 71(1): 33-37.
12.	Baan H, Drossaers-Bakker W, Dubbeldam R, et al. We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis. Clin Rheumatol, 2011, 30(11): 1475-1479.
13.	Miyamoto W, Takao M, Innami K, et al. Technique tip: interposition of extensor digitorum longus after resection arthroplasty of lesser metatarsophalangeal joints for rheumatoid forefoot deformity. Foot Ankle Int, 2011, 32(2): 211-214.
14.	van der Heide HJ, Louwerens JW. Reconstructing the rheumatoid forefoot. Foot Ankle Surg, 2010, 16(3): 117-121.
15.	Duan X, Kadakia AR. Salvage of recurrence after failed surgical treatment of hallux valgus. Arch Orthop Trauma Surg, 2012, 132(4): 477-485.
16.	Hulse N, Thomas AM. Metatarsal head resection in the rheumatoid foot: 5-year follow-up with and without resection of the first metatarsal head. J Foot Ankle Surg, 2006, 45(2): 107-112.
17.	Krause FG, Fehlbaum O, Huebschle LM, et al. Preservation of lesser metatarsophalangeal joints in rheumatoid forefoot reconstruction. Foot Ankle Int, 2011, 32(2): 131-140.
18.	呂厚山, 寇伯龍, 袁燕林, 等. 跖骨頭切除的手術方法及療效分析24例類風濕性關節炎前足矯形. 中華骨科雜志, 1996, 16(1): 31-33.
19.	Rosenbaum D, Timte B, Schmiegel A, et al. First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot. Foot Ankle Int, 2011, 32(6): 589-594.

1. 過邦輔. 類風濕性關節炎 (十) ——踝關節與足類風濕性關節炎的外科治療. 中華骨科雜志, 1998, 18(10): 637-640.
2. Fishman SA. Rheumatoid arthritis with forefoot reconstruction. J Foot Surg, 1989, 28(3): 204-207.
3. Amin A, Cullen N, Singh D. Rheumatoid forefoot reconstruction. Acta Orthop Belg, 2010, 76(3): 289-297.
4. McKinley JC, Shortt N, Arthur C, et al. Outcomes following pantalar arthrodesis in rheumatoid arthritis. Foot Ankle Int, 2011, 32(7): 681-685.
5. Coughlin MJ, Mann RA. Hallux valgus//Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. 8th ed. St. Louis: Mosby, 2006: 184-354.
6. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum, 1988, 31(3): 315-324.
7. Bolland BJ, Sauvé PS, Taylor GR. Rheumatoid forefoot reconstruction: first metatarsophalangeal joint fusion combined with Weil’s metatarsal osteotomies of the lesser rays. J Foot Ankle Surg, 2008, 47(2): 80-88.
8. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
9. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med, 2011, 365(23): 2205-2219.
10. Doorn PF, Keijsers NL, van Limbeek J, et al. A clinical classification system for rheumatoid forefoot deformity. Foot Ankle Surg, 2011, 17(3): 158-165.
11. van Tuyl LH, Britsemmer K, Wells GA, et al. Remission in early rheumatoid arthritis defined by 28 joint counts: limited consequences of residual disease activity in the forefeet on outcome. Ann Rheum Dis, 2012, 71(1): 33-37.
12. Baan H, Drossaers-Bakker W, Dubbeldam R, et al. We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis. Clin Rheumatol, 2011, 30(11): 1475-1479.
13. Miyamoto W, Takao M, Innami K, et al. Technique tip: interposition of extensor digitorum longus after resection arthroplasty of lesser metatarsophalangeal joints for rheumatoid forefoot deformity. Foot Ankle Int, 2011, 32(2): 211-214.
14. van der Heide HJ, Louwerens JW. Reconstructing the rheumatoid forefoot. Foot Ankle Surg, 2010, 16(3): 117-121.
15. Duan X, Kadakia AR. Salvage of recurrence after failed surgical treatment of hallux valgus. Arch Orthop Trauma Surg, 2012, 132(4): 477-485.
16. Hulse N, Thomas AM. Metatarsal head resection in the rheumatoid foot: 5-year follow-up with and without resection of the first metatarsal head. J Foot Ankle Surg, 2006, 45(2): 107-112.
17. Krause FG, Fehlbaum O, Huebschle LM, et al. Preservation of lesser metatarsophalangeal joints in rheumatoid forefoot reconstruction. Foot Ankle Int, 2011, 32(2): 131-140.
18. 呂厚山, 寇伯龍, 袁燕林, 等. 跖骨頭切除的手術方法及療效分析24例類風濕性關節炎前足矯形. 中華骨科雜志, 1996, 16(1): 31-33.
19. Rosenbaum D, Timte B, Schmiegel A, et al. First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot. Foot Ankle Int, 2011, 32(6): 589-594.

《中國修復重建外科雜志》

類風濕性關節炎前足畸形重建手術的近期療效

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國修復重建外科雜志》

類風濕性關節炎前足畸形重建手術的近期療效

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料