硅橡胶假体置换治疗类风湿性跖趾关节病

目的 :探寻类风湿性前足病损的外科治疗方法及效果。方法 :对女性患者 6例 9足 13个RA跖趾关节进行Swan son双柄铰链式硅橡胶假体置换成形术 ,其中 9个第 1跖趾关节 ,第 2及第 3跖趾关节各 2个 ,同期合并手术 3 0多项。手术时平均年龄 47岁 (3 0～ 63岁 ) ,RA病程平均 18年 (13～ 2 8年 )。术后平均随访 2年 (1～ 3年 )。采用美国风湿病学会的足百分评分系统进行术前术后评分 ,包括疼痛、行走能力 (含穿鞋情况 )、畸形 ,以及X线片观察等。结果 :外翻术前平均 42 5° (3 0～ 60°) ,术后平均 15° (10～ 2 5°) ;跖趾关节脱位术前 6个 ,其中 4个行假体置换 ,全部矫正 ;跖趾关节活动度术前平均 2 6° (0～ 45°) ,术后平均 46° (3 5～ 60°) ;疼痛全部解除或缓解 ,行走能力增强 ,穿普通鞋。X线片无关节脱位、假体断裂及骨痂过度生长。病人满意度 10 0 %。综合评分术前平均 45分 (2 0～ 5 5分 ) ,术后平均 90分 (65～ 10 0分 )。优良率 89%。结论 :应用Swanson双柄铰链式硅橡胶假体置换成形术治疗RA跖趾关节病损 ,手术操作简单 ,并发症少 ,临床疗效满意     

Structural interaction between bone and implants due to arthroplasty of the first metatarsophalangeal joint

Background

Currently, the metatarsophalangeal joint replacement through a restorative arthroplasty, where implants are used, is a viable invasive surgical medical procedure in the treatment of severe cases of osteoarthritis in this joint, better known as hallux rigidus. However, few things are known about the postoperative complications that implants can cause on the joint, like Swanson and Tornier implants.Research in this field can provide a valuable information that would help the specialist surgeon in the decision-making during the selection of the more suitable joint implant in each patient, as well as the redesign of the devices, to make them more efficient, durable and biocompatible with the human body.

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

 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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)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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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。     

第二跖趾关节移植在掌指关节重建中的应用

目的探讨第二跖趾关节游离移植重建掌指关节的新方法。方法通过对成人废弃下肢标本6侧,在放大6～10倍手术显微镜视下,解剖并观察第二跖趾关节血供及测量关节活动范围的应用解剖学研究,并在该研究基础上,临床采用不同术式的第二跖趾关节移植,修复掌指关节缺损34例。其中对第一掌指关节重建,将游离关节的跖骨直接与掌骨成30°～45°固定。对2～5指掌指关节重建,采用跖骨头下关节面45°截骨,同时将过厚的跖板在保留关节囊完整及部分跖侧屈肌腱鞘的情况下作楔形切除,原跖骨断端重新对合,纵行克氏针固定。结果术后34例掌指关节全部存活。手功能评定:优22例,良7例,可3例,差2例;优良率为85%。X线片显示骨折愈合良好。结论采用跖骨与掌骨成角固定及跖骨头下关节面45°截骨的方法,行第二跖趾关节游离移植重建掌指关节,该方法可行、有效。     

第一跖趾关节融合术与成形术治疗类风湿前足畸形疗效的系统评价

 目的 比较第一跖趾关节融合术与成形术治疗类风湿前足畸形的临床疗效。方法 计算机检索PubMed(1990年1月至2012年6月)、CNKI(1990年1月至2012年6月)、OVID(1996年1月至2012年6月)、中国生物医学文献光盘数据库、EMBASE(1966年1月至2012年6月)、万方数据库(1990年1月至2012年6月)和Cochrane Library(2011年第3期),搜集第一跖趾关节融合术与关节成形术比较治疗类风湿前足畸形的随机对照研究,对纳入的文献选择患者满意度、趾区负重、AOFAS穿鞋评分、外观评分、足功能指数评分、外翻角、第一、二跖骨间角、手术时间、并发症作为系统评价的指标。采用RevMan 5.1进行分析。结果 共纳入5项研究,285例患者。Meta分析显示：第一跖趾关节融合术的AOFAS穿鞋评分、外观评分优于第一跖趾关节成形术［MD=-0.88,95%CI(-1.55,-0.22),P=0.010;MD=-5.04,95%CI(-8.94,-1.14),P=0.01］,矫正第一、二跖骨间角、外翻角的能力较成形组好［MD=1.43,95%CI(0.37,2.48),P=0.008;MD=13.27,95%CI(11.44,15.09),P< 0.00001］、并发症少［OR=2.32,95%CI(1.06,5.05),P=0.03］。而患者满意度、足功能指数评分,两组疗效相当。结论 第一跖趾关节融合术联合二至五趾跖骨头切除成形术治疗类风湿前足畸形,可有效缓解疼痛、改善足的外观及功能、术后并发症少,其疗效优于第一跖趾关节成形术。     

Geometry of the first metatarsophalangeal joint

This study aimed to define the articular geometry of the metatarsophalangeal (MTP) joint of the great toe. Embedded in resin blocks, five pairs of cadaveric first MTP joints (all from men) were sequentially cut in the sagittal plane with a milling machine, removing 0.5 mm of bone in each cut. The photographed cartilaginous outline of each cut was digitized against reference markers, which enabled a computer system to superimpose each outline in three dimensions. The intersesamoidal ridge was found to be parallel to the lateral shaft. The peak of the ridge was just lateral to the midline of the MT head. The articular outline, through the ridge of each sample, was circular; however, other surface contours were noncircular. The undulating plantar aspect of the MTP head formed by the intersesamoidal ridge and related grooves was found to have symmetric relationships to the sesamoid bones and a consistent orientation to the shaft. The rounded distal dorsal aspect of the MTP head showed consistent differences to the concavity formed by the phalangeal base. The sample size is too small for the sizing of prostheses but it is adequate to study the geometry of the MTP joint. More data are needed for the accurate replication of a resurfacing prosthesis and understanding of joint kinematics.     

Early results of ceramic/ceramic fist metatarsophalangeal joint replacement

We set out to evaluate the early outcome of ceramic on ceramic (MOJE) prosthesis in the treatment of hallux rigidus. Between March 2000 and November 2003, 13 patients (14 implants), were treated using the ceramic/ceramic prosthesis. These patients have been followed for an average of 24.46 months. The American Orthopaedic Foot Association scoring system (AOFAS) was used to assess the patients before and after surgery. The average AOFAS score significantly increased from 43.07 pre-operatively to 95.28 post-operatively (P = 0.0001). At 6 months, 12 patients had no pain. The total range of dorsiflexion and plantarflexion improved to greater than 75° in 10 patients. Audible squeaking of the prosthesis, which improved between 3 and 6 months, was noted in 12 patients.The early results are encouraging with good functional outcome. Long-term follow-up is required to assess the durability of the ceramic/ceramic press fit prosthesis.     

类风湿足跖趾关节硅橡胶假体置换术

目的临床观察用硅橡胶假体置换第一跖趾关节矫正类风湿性关节炎(rheumatoidarthritis,RA)前足畸形的疗效。方法2年间对6例RA患者共11个第一跖趾关节行假体置换术。其中男1例 ,女5例 ;随访38～59个月 ,平均49.75个月。术前外翻30°～75° ,平均45.6°;跖内翻10°～25° ,平均16°;关节活动幅度13°～45° ,平均32.5°。结果术后外翻15°～36°,平均24.7°;跖内翻角无明显变化 ;关节活动幅度33°～60.5°,平均48°。患者对手术满意率100 %,术后优良率92.5 %。结论采用自行研制的硅橡胶假体置换第一跖趾关节 ,手术方法简单 ,骨切除量少 ,效果满意。     

Masquelet技术治疗第1跖趾关节痛风性关节炎

目的:探讨采用Masquelet技术治疗第1跖趾关节痛风性关节炎的效果。方法:自2012年2月至2016年5月,采用Masquelet技术治疗7例第1跖趾关节痛风性关节炎患者,其中男5例,女2例;年龄42~58岁,平均50岁。术后定期复查,通过影像学评估骨质愈合情况,并采用美国矫形外科足踝协会(AOFAS)足踝功能评分系统进行综合评价。结果:7例患者均获得随访,时间6~8个月,平均7个月。所有患者伤口达到Ⅰ期愈合,未出现伤口感染、皮瓣坏死等软组织并发症。影像学检查均达到骨性愈合,愈合时间3~4个月,平均3.6个月。AOFAS评分由术前的42.5±4.6提高至术后的85.0±10.5。结论:采用Masquelet技术治疗第1跖趾关节痛风性关节炎具有症状缓解明显、并发症少的优势,可有效改善患者生活质量,是一种全新有效的治疗方式。     

第一跖趾关节痛风石的手术治疗

目的探讨和总结跖趾关节巨大痛风石的治疗方法、疗效分析。方法对12例第一跖趾关节巨大痛风石患者,在综合治疗基础上,行手术治疗,术后长期监控血尿酸。结果本组12例,全部得到随访,随访时间6～24个月,平均13．4个月。关节切口Ⅰ期愈合,仅1例切口出现延迟愈合,占8．3％。术后跖趾关节外观和关节功能满意。结论积极的手术治疗是治疗第一跖趾关节巨大痛风石的有效方法,能减少痛风急性发作的次数,改善足的外观、保护足的功能。     

Total first metatarsophalangeal joint implant arthroplasty: a 30-year retrospective

The first metatarsophalangeal (MTP) joint is a frequent diseased-affected articulation encountered by the foot and ankle surgeon. Arthroplasty remains a favorable option for surgeons, because it preserves motion of the joint. The authors' focus at the Weil Foot and Ankle Institute has been on using double-stem silicone implants with titanium grommets, which may be a viable solution for affected articulations. The authors present their clinical results from over 30 years of experience with total first MTP joint implant arthroplasty at the Weil Foot and Ankle Institute.     

第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻

目的：探讨第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻临床疗效。方法：回顾性分析自2017年3月至2021年8月接受第1跖趾关节融合结合旋转Weil截骨治疗的重度跖内收型拇外翻患者37例（69足）,男8例（11足）,女29例（58足）;年龄67～83(70.03±2.87)岁;左侧3例,右侧2例,双侧32例。分别于术前、术后6周及末次随访时,采用疼痛视觉模拟评分（visual analogue scale,VAS）进行疼痛缓解程度评价。术前及末次随访时采用美国骨科足踝外科学会（American Orthopaedic Foot and Ankle Surgery,AOFAS）前足评分对患足功能进行评价。并测量手术前及末次随访时拇外翻角（hallux valgus angle,HVA）,第1、2跖间角（intermetatarsal angle,IMA）的变化情况。结果：37例（69足）患者获得随访,时间12～48 (22.8±0.6)个月。术后7～10(8.00±1.21)周第1跖趾关节处达到骨愈合,无延迟愈合及不愈合发生。术前HVA (44.30±2.84)°与...     

Salvage arthrodesis for failed first metatarsophalangeal joint arthroplasty: A network meta-analysis

BackgroundWe aim to provide an evidence-based literature review of salvage arthrodesis for failed first metatarsophalangeal joint arthroplasty with a network meta-analysis.MethodsA search of PubMed, Embase and Cochrane databases was conducted in December 2016 which identified 12 relevant articles out of 340 articles assessing the efficacy of salvage arthrodesis for failed joint arthroplasty of the first metatarsophalangeal joint. The 12 studies were assigned a level of evidence (I–V) and interventions were graded a level of recommendation (A–C, I) in support of or against the treatment modality.ResultsThere is fair evidence (grade B) to support salvage arthrodesis with structural bone graft. There is poor evidence (grade C) for salvage arthrodesis without bone graft. There was no good evidence (grade A) to recommend either intervention. Meta-analysis showed that salvage arthrodesis resulted in improved functional outcome over time.ConclusionsSalvage arthrodesis showed good bone union rates and patient satisfaction.Level of Clinical Evidence: III – Systematic Review of Level III studies.     

The double-stemmed silicone-rubber implant for rheumatoid arthritis of the first metatarsophalangeal joint. Long-term results.

Sixty-seven feet in forty-five patients who had rheumatoid arthritis were followed for an average of six years (range, four to ten years) after an operation on the forefoot that included resection of the metatarsophalangeal heads or joints and the insertion of a double-stemmed silicone-rubber implant in the first metatarsophalangeal joint. There were forty-two women and three men, and the average age at the time of the operation was fifty-six years (range, thirty-six to seventy-nine years). The mean duration of known rheumatoid arthritis was fifteen years (range, three to thirty-seven years). Resection of the metatarsophalangeal heads or joints was performed through a plantar approach in forty-one feet and a dorsal approach in twenty-six feet. A double-stemmed silicone-rubber implant was placed in the first metatarsophalangeal joint in all feet. Each patient was evaluated clinically and radiographically with use of a foot-scoring system that was developed for this study. The results were assessed for relief of pain, ability to walk (including the use of shoes), presence of calluses or deformity, and radiographic findings. The average preoperative foot score was 47 points; the score had improved to an average of 81 points at the latest follow-up examination. A good or excellent result was obtained in fifty-eight feet (87 per cent). Complications were infrequent. In three feet, there was delayed healing of the wound; three implants were removed because of dislocation and infection; and four feet had revision to correct deformities of the lesser toes.     

The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis

We performed a retrospective study in 188 patients (254 feet) with rheumatoid arthritis and compared the late results of Keller's procedure with those of Hueter-Mayo's technique after 7.9 years. More than 60% of the Keller group and 30% of the Hueter-Mayo group were suffering from persistent metatarsalgia due to increased forefoot pressure as well as experiencing pain around the great toe. Plantar callosities, recurrent hallux valgus deformity, lack of plantar flexion and weakened push-off were more frequent after Keller's procedure.     

改良第二跖趾关节移植修复木工机械致掌指关节背侧缺损

目的 探讨一种新的改良第二跖趾关节移植修复木工机械致掌指关节背侧缺损的方法及临床疗效.方法 2006年12月至2011年12月,针对木工机械致掌指关节损伤的特点,设计并改良第二跖趾关节复合组织瓣,经过重建,保留复合组织瓣背侧半,用于修复掌指关节冠状面背侧复合组织缺损共16例23个掌指关节.结果 17个修复的掌指关节获得随访,时间6～24个月,X线片提示骨骼愈合.重建掌指关节均获得较好的功能恢复.按中华医学会手外科分会拇手指再造功能评定试用标准评定,优良率为94.12％.结论 改良第二跖趾关节移植修复木工机械致掌指关节背侧缺损临床可行,能有效改善损伤掌指关节的功能.     

Modification of the total first metatarsophalangeal joint implant arthroplasty

The Swanson Silastic HP 100 Flexible Hinge Toe Implant (Dow Corning Wright, Arlington Tennessee) displays superior tensile, elongation and tear propagation strength in comparison to other silicone implant materials. It is, however, subject to many factors which may shorten its life-span. One reason for such failure has been attributed to the irregular contour of bone ends created after metatarsophalangeal joint arthroplasty, resulting in abrasion shards and shearing fractures of the implant stems and hinge. Titanium grommets were developed to alleviate this factor. This case report demonstrates a complication subsequent to total first metatarsophalangeal joint implant arthroplasty and the effectiveness of the Swanson Flexible Hinge Toe Joint Grommet. (Dow Corning Wright, Arlington, Tennessee).     

First metatarsophalangeal joint replacement: Long-term results of a double stemmed flexible silicone prosthesis

Background

The aim of this retrospective study was to evaluate the long-term results of a Swanson type silicone prosthesis used for the first metatarsophalangeal (FMTP) joint replacement. It compares implants with and without the use of grommets.

Methods

Fifty-nine FMTP joints were replaced. The average follow-up period was 9 years. Subjective and clinical findings were scored according to the AOFAS-HMI (American Orthopedic Foot and Ankle Society-Hallux Metatarsophalangeal-Interphalangeal) score. X-ray examination was carried out by evaluation of the presence of reactive bone areas around the implant.

Results

Ninety-five percent of patients had relief of pain. Clinical findings showed a reasonable function (range of motion >30°) in 77% of the FMTP joints. A trend for decrease in radiolucency and lytic bone was seen in areas around the implant with the use of grommets.

Conclusion

The prosthesis shows good results concerning pain relief and a reasonable to good function (>30° range of motion) of the FMTP joint in most patients. Reactive bone areas around the implant decreased by the use of grommets.     

分期手术治疗第1跖趾关节巨大痛风石的临床研究

目的:探讨分期手术治疗第1跖趾关节巨大痛风石的近期临床疗效。方法 :自2015年1月至2016年12月,采用分期手术治疗第1跖趾关节巨大痛风石患者12例,全部为男性;年龄45～73岁;右足6例,左足6例;保守治疗2年以上,双能CT检查明确通风石大小及部位;经X线片检查均可见第1跖趾关节骨质破坏。所有患者Ⅰ期手术行痛风病灶的彻底清除及克氏针临时固定,待局部软组织条件稳定后再行跖趾关节的植骨融合内固定手术。比较手术前后血尿酸含量,患肢畸形矫正及并发症情况,采用VAS评分评价疼痛缓解程度。结果:所有患者顺利完成手术,且获得随访,时间9～13个月。12例患者VAS评分由术前的6～9分降低至术后7周的0～1分;血尿酸含量由术前的443～501μmol/L降低至术后7周的307～330μmol/L;术后5～7个月足部第1跖趾关节畸形矫正、外形恢复。术后1例发生切口感染、皮缘坏死,经清创及换药处理后切口愈合。结论:分期手术治疗足部第1跖趾关节巨大痛风石,可矫正关节畸形,恢复第1跖趾关节外形,改善患足疼痛,有利于控制血尿酸含量,且并发症少。