Coughlin Michael J, Shurnas Paul S
St. Alphonsus Regional Medical Center, Boise, ID, USA.
J Bone Joint Surg Am. 2004 Sep;86-A Suppl 1(Pt 2):119-30. doi: 10.2106/00004623-200409001-00003.
There have been few long-term studies documenting the outcome of surgical treatment of hallux rigidus. The purposes of this report were to evaluate the long-term results of the operative treatment of hallux rigidus over a nineteen-year period in one surgeon's practice and to assess a clinical grading system for use in the treatment of hallux rigidus.
All patients in whom degenerative hallux rigidus had been treated with cheilectomy or metatarsophalangeal joint arthrodesis between 1981 and 1999 and who were alive at the time of this review were identified and invited to return for a follow-up evaluation. At this follow-up evaluation, the hallux rigidus was graded with a new five-grade clinical and radiographic system. Outcomes were assessed by comparison of preoperative and postoperative pain and AOFAS (American Orthopaedic Foot and Ankle Society) scores and ranges of motion. These outcomes were then correlated with the preoperative grade and the radiographic appearance at the time of follow-up.
One hundred and ten of 114 patients with a diagnosis of hallux rigidus returned for the final evaluation. Eighty patients (ninety-three feet) had undergone a cheilectomy, and thirty patients (thirty-four feet) had had an arthrodesis. The mean duration of follow-up was 9.6 years after the cheilectomies and 6.7 years after the arthrodeses. There was significant improvement in dorsiflexion and total motion following the cheilectomies (p = 0.0001) and significant improvement in postoperative pain and AOFAS scores in both treatment groups (p = 0.0001). A good or excellent outcome based on patient self-assessment, the pain score, and the AOFAS score did not correlate with the radiographic appearance of the joint at the time of final follow-up. Dorsiflexion stress radiographs demonstrated correction of the elevation of the first ray to nearly zero. There was no association between hallux rigidus and hypermobility of the first ray, functional hallux limitus, or metatarsus primus elevatus.
Ninety-seven percent (107) of the 110 patients had a good or excellent subjective result, and 92% (eighty-six) of the ninety-three cheilectomy procedures were successful in terms of pain relief and function. Cheilectomy was used with predictable success to treat Grade-1 and 2 and selected Grade-3 cases. Patients with Grade-4 hallux rigidus or Grade-3 hallux rigidus with <50% of the metatarsal head cartilage remaining at the time of surgery should be treated with arthrodesis.
很少有长期研究记录僵硬性拇趾的手术治疗结果。本报告的目的是评估一位外科医生在19年的实践中对僵硬性拇趾进行手术治疗的长期结果，并评估一种用于僵硬性拇趾治疗的临床分级系统。
确定所有在1981年至1999年间接受过切骨术或跖趾关节融合术治疗退行性僵硬性拇趾且在本次评估时仍存活的患者，并邀请他们回来进行随访评估。在这次随访评估中，使用一种新的五级临床和影像学系统对僵硬性拇趾进行分级。通过比较术前和术后的疼痛、美国矫形足踝协会（AOFAS）评分以及活动范围来评估结果。然后将这些结果与术前分级以及随访时的影像学表现相关联。
114例诊断为僵硬性拇趾的患者中有110例回来进行了最终评估。80例患者（93足）接受了切骨术，30例患者（34足）接受了关节融合术。切骨术后的平均随访时间为9.6年，关节融合术后为6.7年。切骨术后背屈和总活动度有显著改善（p = 0.0001），两个治疗组的术后疼痛和AOFAS评分均有显著改善（p = 0.0001）。基于患者自我评估、疼痛评分和AOFAS评分得出的良好或优秀结果与最终随访时关节的影像学表现无关。背屈应力X线片显示第一跖骨抬高矫正至接近零。僵硬性拇趾与第一跖骨活动过度、功能性拇趾僵硬或第一跖骨抬高之间无关联。
110例患者中有97%（107例）主观结果良好或优秀，93例切骨术中有92%（86例）在缓解疼痛和功能方面取得成功。切骨术用于治疗1级和2级以及部分3级病例可取得可预测的成功。对于4级僵硬性拇趾或手术时第一跖骨头软骨剩余不足50%的3级僵硬性拇趾患者，应采用关节融合术治疗。
