Hanyu T, Yamazaki H, Ishikawa H, Arai K, Tohyama C T, Nakazono K, Murasawa A
Department of Orthopedic Surgery, Niigata University School of Medicine, 1 Asahimachi-dori, Niigata 951-8510, Japan.
J Orthop Sci. 2001;6(2):141-7. doi: 10.1007/s007760100062.
We report the long-term clinical results and survival rate of the implant in flexible hinge toe implant arthroplasty of the first metatarsophalangeal joint, combined with a shortening oblique osteotomy of the metatarsal neck in the lateral toes, in patients with rheumatoid arthritis. Between 1983 and 1990, arthroplasty was performed on 97 feet in 66 patients. Twenty-seven patients died; follow-up information was available for 60 feet in the remaining 39 patients, who were followed for an average of 12 years. Twenty-nine patients (74%) were satisfied with the outcome after surgery, 7 were satisfied but had some pain or recurrent deformities, and 3 were unsatisfied. Radiologically, visible fracture was identified in nine implants. Four implants were removed because of infection (n = 2) or recurrent deformity (n = 2); no implant was removed because silicone synovitis developed. With revision as the endpoint, the implant survival rate was 93% at 10 years, and with radiographic implant fracture as the endpoint, the implant survival rate was 87% at 10 years. Shortening oblique osteotomy of the lateral toes appeared to decrease the rate of implant fracture and should be performed concomitantly with implantation when rheumatoid forefoot deformities are being reconstructed.
我们报告了类风湿性关节炎患者第一跖趾关节柔性铰链趾植入物关节成形术联合外侧趾骨跖骨颈缩短斜行截骨术的长期临床结果和植入物存活率。1983年至1990年期间，对66例患者的97只脚进行了关节成形术。27例患者死亡；其余39例患者中60只脚有随访信息，平均随访12年。29例患者（74%）对手术结果满意，7例满意但有一些疼痛或畸形复发，3例不满意。影像学检查发现9枚植入物有明显骨折。4枚植入物因感染（n = 2）或畸形复发（n = 2）而取出；没有植入物因发生硅酮滑膜炎而取出。以翻修为终点，10年时植入物存活率为93%，以影像学植入物骨折为终点，10年时植入物存活率为87%。外侧趾骨缩短斜行截骨术似乎可降低植入物骨折率，在重建类风湿性前足畸形时应与植入术同时进行。
