拇长屈肌腱病变与类风湿关节炎拇外翻间的关系

目的探讨拇长屈肌腱(Flexor Hallucis Longus tendon,FHL)病变与类风湿关节炎(Rheumatoid arthri-tis,RA)拇外翻间的相关性。方法回顾性分析2010年2月至2011年6月因足部疼痛于我院就诊的60例(120足)RA患者资料。根据超声探查拇长屈肌腱病变情况的结果将患者分为3组:肌腱完整组(A组,45足),肌腱周围炎症组(B组,49足),肌腱断裂组(C组,26足)。所有患者均摄足部负重正位X线片,并基于X线片行拇外翻角及第一、二跖骨间角的测量,对拇长屈肌腱病变与拇外翻的严重程度进行相关性分析。结果 A组HVA平均(31.6±15.9)°,IMA平均(10.1±4.5)°;B组HVA平均(43.3±13.7)°,IMA平均(12.4±4.5)°;C组HVA平均(41.6±16.9)°,IMA平均(12.1±3.7)°。3组间HVA存在显著统计学差异(P=0.001);3组间IMA存在显著统计学差异(P=0.001)。LSD两两比较,HVA:三组间存在显著统计学差异;IMA:A组与B组间存在统计学差异(P<0.01),A、C两组及B、C两组间无明显统计学差异(P>0.05)。分别对3组内的HVA及IMA进行Pearson相关性分析,A组HVA与IMA相关,Pear-son相关系数为0.45,P=0.002;B组HVA与IMA相关,Pearson相关系数为0.36,P=0.01;C组HVA与IMA间无相关性,Pearson相关系数为-0.11,P=0.59。结论 FHL病变在RA患者中常见,FHL病变(炎症及断裂)并非RA拇外翻的起始因素,但会加重拇外翻的畸形严重程度。

Relations between Flexor Hallucis Longus tendon changes and Hallux valgus in patients with Rheumatoid arthritis

Objective To assess relations between tenosynovitis or rupture of the Flexor Hallucis Longus （FHL） tendon and Hallux valgus in patients with rheumatoid arthritis（RA）. Methods From February 2010 to June 2012, 60 RA patients （120 feet） with Hallux valgus were analysed. In accordance with the results of Ultrasound examination, the FHL changes were divided into 3 groups. Group A with normal FHL included 45 feet, group B with FHL tenosynovitis included 49 feet, and group C with FHL rupture included 26 feet. Load hearing radiographs were taken, and Hallux val- gus - related parameters such as Hallux valgus angle（HVA） and Intermetatarsal angle（IMA） were measured and com- pared among the groups. Results Between GROUP A,B and C,The mean HVA was 31.6±15.9° vs 43.3±13.7° and 41.6±16.9°, the mean TM1 was10.1±4.5° vs 12.4±4.5° and 12.1~：3.7° ,significant statistics difference among these parameters were found between groups. Conclusion FHL changes were common in RA patients and its severity had pos- itive relation with Hallux valgus.