Oommen Anil Thomas, Mannam Ebenezer, Partheebarajan S, Samuel Solomon
Department of Surgery, Schieffelin Leprosy Research and Training Centre, Karigiri, Tamil Nadu, India.
Lepr Rev. 2003 Mar;74(1):63-7.
The cases of 30 patients with septic arthritis of the metatarsophalangeal (MTP) joints as a complication of plantar ulceration in leprosy who underwent excision arthroplasty and primary closure of the plantar ulcer were reviewed. Twenty-two of these patients were male. The commonest site of MTP joint involvement was the first MTP joint. The average longitudinal diameter of ulcers was 2cm, and most ulcers were oval in shape. Diagnosis was made on the basis of signs of infection over the MTP joint, discharge from the ulcer and examination with a probe. Infection in the joint ranged from simple synovial discharge to seropurient or purulent discharge. Treatment involved excision arthroplasty of the MTP joint, excision of the ulcer with primary closure of the plantar incision and dorsal or lateral drainage depending upon the direction in which the infection extended. In two patients, the plantar wound could not be closed as it was too large. Healing of the plantar incision took 2 weeks in 12 patients and 3 weeks in 14 patients. In four patients, healing did not occur by primary intention. In a follow up of 1-2 years, there was no recurrence in 24 patients, while four patients had recurrent simple ulceration. Two patients were lost to follow up. Review of the results of this procedure dealing with septic arthritis of MTP joints secondary to plantar ulceration shows that primary healing of the plantar incision could be achieved in 3 weeks. With regard to recurrence, even though only four out of 28 ulcers treated by this procedure recurred, other contributing factors should be considered in a prospective control study to support the view that this procedure has contributed to non-recurrence.
回顾了30例因麻风足底溃疡并发跖趾关节（MTP）化脓性关节炎而接受关节切除成形术及足底溃疡一期缝合的患者情况。其中22例为男性。MTP关节受累最常见的部位是第一跖趾关节。溃疡的平均纵径为2cm，多数溃疡呈椭圆形。根据MTP关节处的感染体征、溃疡分泌物及探针检查做出诊断。关节感染范围从单纯滑膜渗出到浆液脓性或脓性渗出。治疗包括MTP关节切除成形术、溃疡切除及足底切口一期缝合，根据感染蔓延方向行背侧或外侧引流。2例患者因足底伤口过大无法缝合。12例患者足底切口愈合时间为2周，14例为3周。4例患者一期愈合未成功。在1至2年的随访中，24例患者无复发，4例患者出现复发性单纯溃疡。2例患者失访。对该治疗足底溃疡继发MTP关节化脓性关节炎的手术结果进行回顾发现，足底切口可在3周内实现一期愈合。关于复发，尽管该手术治疗的28例溃疡中仅4例复发，但在一项前瞻性对照研究中应考虑其他相关因素，以支持该手术有助于防止复发这一观点。
