Fujioka H, Doita M, Saura R, Mizuno K
Department of Orthopaedic Surgery, School of Medicine Kobe University, Hyogo.
Ryumachi. 1999 Jun;39(3):561-7.
We have reviewed the results of reconstruction of the forefoot in rheumatoid patients with arthroplasty using a Swanson flexible hinge toe implant for the great toe and with resection arthroplasty for the lateral four toes. The follow-up averaged 8 years (range, 5-11 years). All patients were female and an average age was 52 (range, 31-72 years). Preoperative and postoperative hallux valgus angle (HVA), the angles between the axes of the first and second metatarsal shafts (M1-M2) and the first and fifth metatarsal shafts (M1-M5) were measured radiographically. Breakage of the implant and radiolucencies around the implant on X-ray were evaluated. Preoperative average HVA, M1-M2 and M1-M5 were 31, 10, and 30 respectively. Postoperative average HVA, M1-M2, and M1-M5 were 17, 10, and 28 respectively. Breakage of the implant was present in 77% of the feet and the radiolucencies around the implant was present in 63% of the feet. Although only one foot was performed revision surgery for severe pain and breakage of the implant, more than 95% of the feet obtained pain relief. We found that this type of operation was very effective in relieving pain in rheumatoid patients.
我们回顾了类风湿性关节炎患者前足重建的结果，其中拇趾采用斯旺森柔性铰链趾植入物进行关节成形术，外侧四趾采用切除关节成形术。随访时间平均为8年（范围5 - 11年）。所有患者均为女性，平均年龄52岁（范围31 - 72岁）。术前和术后通过X线测量拇外翻角（HVA）、第一和第二跖骨干轴线之间的角度（M1 - M2）以及第一和第五跖骨干轴线之间的角度（M1 - M5）。评估植入物的断裂情况以及X线片上植入物周围的透光影。术前平均HVA、M1 - M2和M1 - M5分别为31°、10°和30°。术后平均HVA、M1 - M2和M1 - M5分别为17°、10°和28°。77%的足部出现植入物断裂，63%的足部出现植入物周围透光影。虽然只有一只脚因植入物严重疼痛和断裂进行了翻修手术，但超过95%的足部疼痛得到缓解。我们发现这种手术方式对缓解类风湿性关节炎患者的疼痛非常有效。
