类风湿性前足畸形的手术治疗体会

目的 探讨第1跖趾关节融合联合跖骨头切除术治疗类风湿性前足畸形的临床疗效.方法 回顾性分析自2018-01-2020-04诊治的16例(24足)类风湿性前足畸形,采用第1跖趾关节融合术矫正足拇外翻畸形,采用跖骨头切除术治疗类风湿性前足畸形中第2～5趾畸形.结果 15例(23足)获得随访,1例(1足)失访,随访时间平均1...     

类风湿关节炎前足畸形手术治疗的中长期疗效评价

背景:类风湿关节炎(RA)晚期常累及前足小关节,造成前足畸形.目前关于手术治疗RA前足畸形的中长期随访研究较少.目的:评估手术治疗RA前足畸形的中长期疗效.方法:回顾性分析2010年11月至2019年7月诊断为RA前足畸形并行手术治疗的15例患者(22足)的临床资料,其中男3例,女12例,平均年龄(60±12)岁.记录...     

类风湿足前足重建的研究进展

类风湿关节炎是一种全身系统性疾病,发生率为0．5％～1％,女性高于男性。在任何年龄组中都有可能发病,四、五十岁为好发年龄,发病率无地域和种族差异。约有20％的类风湿关节炎患者自足踝部起病,有超过半数的患者出现足踝功能受限,并且自起病后的十年内几乎所有患者都会出现足畸形。     

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

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...     

跖骨全切除前足再造术

跖骨全切除前足再造术陈宝兴ＲｉｔａＲａｅＦｏｎｔｅｎｏｔＤ．Ｐ．Ｍ前言：１９１１年Ｈｏｆｍａｎ首次用跖骨头全切除术治疗由类风湿性关节炎所致的前足畸形。主要包括趾外翻、爪形趾及跖骨头在前足跖面突出。Ｈｏｆｍａｎ首次报告的手术方法是全部切除５个跖骨头，...     

跖骨头切除术治疗类风湿前足畸形（附5例报告）

跖骨头切除术治疗类风湿前足畸形（附５例报告）李为，贾佑民，窦宝信，康倩，周乙雄类风湿关节炎患者晚期表现为爪形足，外翻以及跖趾关节脱位等前足畸形，妨碍穿鞋和行走。Ｈｏｆｆ－ｍａｎ￣［１］（１９１２）首次提出跖骨头切除（ｍｅｔａｔａｒｓａｌｈｅａｄｒｅ－...     

类风湿性关节炎（十）——踝关节与足类风湿性关节炎的外科治疗

踝关节与足部类风湿性关节炎的治疗需要确定对病理的评定和疾病的自然发展史，因此，严重的病残足包括：（１）多发性关节破坏，它可表现为不同的病程演进和两足病残的不对称分布；（２）多见进行性，但常为无规律性病理改变，故易导致对足病缺乏外科学的整体概念；（３）...     

前足多发畸形的微创手术治疗

目的 :研究采用微创手术 ,一次性矫正前足多发畸形。方法 :2 70例 (5 3 0足 )采用微创截骨 ,手法折骨 ,骨赘削磨 ,软组织松解等方法 ,术毕采用“8”字绷带加宽胶布固定 ,采用特制矫形鞋早期下床活动 ,4～ 6周去除固定。随访时间 1～ 13年 ,平均 6 2年。结果 :1年优良率为 10 0 %,2年优良率为 94 5 %,10年优良率为 90 4%。术前外翻角 (HVA)与第一、二跖间角 (IMA)大小有显著相关性 ,手术前后相关系数分别为 0 475和 0 3 83。结论 :本方法能够一次矫正前足多发畸形 ,有效地解决患者足部的症状 ,使足部软组织力量平衡 ,恢复足部正常行走功能。     

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。     

手部类风湿性关节炎的手术治疗

类风湿性关节炎是一种常见的累及多个关节的慢性炎性自身免疫性疾病,所有类风湿性关节炎均会累及手部。绝大多数病例在病情反复发作和加重的过程中,逐渐出现滑膜、关节软骨、软骨下骨面、关节周围的韧带、肌腱等组织损害,导致关节畸形和手部功能障碍。     

Rheumatoid forefoot reconstruction: 1st metatarsophalangeal fusion and excision arthroplasty of lesser metatarsal heads

This is a retrospective review of 66 feet (mean follow-up of 3 years) in 43 patients with painful severe rheumatoid forefoot deformities. All were treated by arthrodesis of the first metatarsophalangeal (MTP) joint through a dorsomedial incision and excision of the lesser metatarsal heads through a separate plantar approach. The mean post-operative AOFAS scores were 65.94 (range: 32 to 82). The mean post-operative Foot Function Index (FFI) was 0.47 (range: 0.23 to 0.63). Eighty five percent (57/67 feet) reported excellent or good pain relief, improved cosmetic appearance, and improved footwear comfort. The mean hallux valgus angles improved from 39 degrees to 16 degrees and the intermetatarsal angle from 16 degrees to 8 degrees. Five feet had nonunion of the 1st MTP joint arthrodesis. There were five re-operations for non-union of the 1st MTP joint arthrodesis. The success of the operation as evidenced by this study depends upon attention to metatarsal length harmonisation, stabilisation of the 1st MTP joint and thereby even distribution of loading of the forefoot. The poor results in this study were as a result of a failure to secure the stability of the 1st MTP joint.     

Rheumatoid forefoot reconstruction: Outcome of 1st metatarsophalangeal joint fusion and the Stainsby procedure in the lesser toes

BackgroundRheumatoid arthritis is a chronic inflammatory disease involving connective tissue and joints. The most common rheumatoid forefoot deformities are hallux valgus and clawed lesser toes. There are a number of surgical procedures that have been described offering symptomatic relief and anatomical correction.ObjectivesThis prospective case series aims to assess outcome in patients with rheumatoid forefoot deformities who underwent a novel combination of 1st metatarsophalangeal joint fusions and Stainsby procedures.MethodsThirteen procedures were performed on 12 consecutive patients with an age range of 55–71 (mean = 62) between 02/2009 and 05/2011. AOFAS scoring was performed preoperatively and again six and 12 months post-surgery. Hallux valgus (HVA) and intermetatarsal angles (IMA) were measured preoperatively and six weeks and six months postoperatively.ResultsThe mean AOFAS score increased from 46 to 72, 12 months postoperatively. The mean HVA reduced from 48° preoperatively to 14° six months postoperatively. The IMA decreased from 15° to 10° six months postoperatively.ConclusionsThe novel approach of 1st metatarsophalangeal fusion combined with lesser toe metatarsal head sparing is an effective procedure that reduces forefoot deformity and pain.     

Resection or preservation of the metatarsal heads in rheumatoid forefoot surgery? A randomised clinical trial

Background

Despite impressive results of the pharmacological management of rheumatoid arthritis, still certain patients suffer from rheumatoid forefoot problems. Surgical treatment of these forefoot deformities can be an option. In literature no high-quality studies on this topic can be found.The goal of present study is to compare the results of a metatarsal head (MTH) resecting technique with a MTH preserving technique in the operative treatment of severe rheumatoid forefoot deformity.

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...     

截骨融合治疗严重僵硬性马蹄足畸形的临床疗效观察

目的 :探讨截骨融合术矫正严重僵硬性马蹄足畸形的临床疗效。方法 :自2010年4月至2015年10月,采用空心钉行截骨关节融合术矫正13例(16足)严重僵硬性马蹄足畸形患者,其中男6例,女7例;年龄39~62(49.6±5.3)岁;病程5~27(9.0±4.8)年。采用三关节截骨融合术6例(9足),四关节截骨融合术4例(4足),胫距跟关节截骨融合术3例(3足)。所有患者术前表现为患足疼痛、足跟不能接触地面、无法行走。观察患者术后并发症情况,并采用AOFAS评分进行临床疗效评定。结果:13例患者获得随访,时间18~24个月,平均20个月。术后仅有1例出现伤口部分皮肤坏死,予伤口换药、抗感染治疗后痊愈。末次随访时所有患足达到骨性愈合,时间12~16周,平均13.2周。AOFAS评分由术前的11.85±10.66提高至术后的81.38±3.69,差异有统计学意义(t=-25.67,P0.05);其中良15足,可1足。结论 :根据患者情况,可采用胫距跟关节融合、三关节或者四关节融合术矫正部分严重僵硬性马蹄足畸形,并可取得较满意的临床疗效。     

A pilot comparison of forefoot plantar pressures in newly diagnosed rheumatoid arthritis patients and non-rheumatic subjects

BackgroundIn rheumatoid arthritis (RA) forefoot pathology is often related to increased peak plantar pressures under the metatarsal heads.ObjectivesThis study sought to assess peak plantar pressures in newly diagnosed RA patients compared to non-rheumatic subjects.MethodPlantar pressure in a group of 10 pain free RA patients diagnosed within two years before the starting date of the study and 10 healthy volunteers matched for gender, age and weight were assessed. Each group consisted of seven females and three males aged between 30 and 55 years.ResultsThe results showed no significant difference (ρ = 0.420) at the hallux, however there was a statistical difference in all the other regions (ρ = 0.000 and p = 0.011 for 1st MPJ and 2nd–4th MPJ respectively and p = 0.007 for 5th MPJ). The RA group had higher pressure underneath the 1st and 2nd–4th MPJ regions and lower pressures underneath the 5th MPJ.ConclusionAlthough it is for a small group of patients, the results from this pilot study show that even at an early stage of RA, forefoot pressures are shifted toward the medial MPJs.     

第1跖列稳定术联合第2-5跖骨头切除术治疗晚期类风湿关节炎前足畸形

目的:介绍第1跖列稳定联合第2-5跖骨头切除术治疗晚期类风湿关节炎(rheumatoid arthritis,RA)前足畸形的手术方式并对中短期临床疗效进行评价。方法:2006年10月至2010年8月收治的晚期RA前足畸形97例患者进行回顾性分析。其中,男9例,女88例;单足65例,双足32例;年龄36～67岁,平均54岁;病程6～32年,平均17年。所有病例存在严重的拇外翻同时合并第1跖跗关节不稳,第2-5跖趾关节脱位及僵硬。采用第1跖列稳定联合第2-5跖趾关节成形术对其进行治疗。通过影像学资料测量拇外翻角(Hallux valgus angle,HVA),跖骨间角(intermetatarsal angle,IMA),并采用JSSF(Japanese Society for Surgery of the Foot)评分对临床疗效进行评估。结果:97例患者中失访5例(7足),平均随访37个月(6～52个月),其中1例术后1年因急性心肌梗死死亡。术前JSSF评分(33.2±8.2)分,末次随访时改善至(67.3±3.1)分(P<0.01);HVA由术前(50.0±11.8)°纠正至术后(21.2±3.2)°(P<0.01);IMA由术前(15.5±3.6)°纠正至术后(9.7±6.6)°(P<0.01)。发生跖趾关节骨不连4足;术后8～11月摄片发现第1楔骨内高密度改变3足;出现拇内侧切口延迟愈合9足;跖趾关节内固定感染2足;跖跗关节内固定感染1足;第2-5跖趾关节术后16足畸形复发。结论:晚期RA患者的前足病变涉及范围广,畸形严重。采用第1跖趾关节融合联合Lapidus术式重建第1跖列的外形及稳定性,跖骨头切除术纠正第2-5跖趾关节畸形的方式重建前足疗效可靠。该术式适用于重度拇外翻合并IMA增大及第1跖跗关节不稳,同时存在第2-5跖趾关节僵硬性半脱位的患者。     

Biomechanical comparison of first metatarsophalangeal joint arthrodeses using triple-threaded headless screws versus partially threaded lag screws

BackgroundTriple-threaded, cannulated headless screws of varying thread diameters and pitch are designed to maintain thread length across the arthrodesis plane, provide joint compression, and reduce countersinking. This study tested the biomechanical fixation strength of conventional partially threaded lag screws compared to triple-threaded headless screws in first metatarsophalangeal joint arthrodesis.MethodsFirst metatarsophalangeal joint arthrodesis using a crossed screw technique was performed on 11 paired, preserved cadaver first rays with two 4.0-mm triple-threaded, cannulated headless screws or two 4.0-mm partially threaded, cannulated lag screws. The constructs were tested to failure through dorsally directed cantilever bending.ResultsThe triple-threaded, cannulated headless screws displayed significantly greater bending stiffness (p = 0.017) and failure load (p = 0.040) during load-to-failure testing compared to the partially threaded, cannulated lag screws.ConclusionsTriple-threaded, cannulated headless screws may be a viable alternative to partially threaded lag screws in first metatarsophalangeal arthrodesis.