Grondal Lollo, Hedstrom Margareta, Stark Andre
The Redcross Hospital, Department of Orthopaedic Rehabilitation, Brinellvagen 2, Stockholm, S-114 28 Sweden.
Foot Ankle Int. 2005 Feb;26(2):135-9. doi: 10.1177/107110070502600204.
Painful forefoot deformity from rheumatoid arthritis can be treated with resection of the lesser metatarsal heads combined with either resection or arthrodesis of the first metatarsophalangeal (MTP) joint.
In a prospective, randomized study we compared arthrodesis of first MTP joint with Mayo resection as part of total forefoot reconstruction in patients with painful forefoot deformity from rheumatoid arthritis. The lesser metatarsal heads were resected and extensor tenotomy was done in all patients. Thirty-one patients were randomized to either the arthrodesis or resection group.
After a mean followup of 36 (26 to 52) months, the median subjective satisfaction score was 96 points out of 100 in the resection group and 92 points in the arthrodesis group. Significant improvements in pain, handicap, and activity according to Foot Function Index (FFI) were found in both groups (p <0.001 except for handicap in resection group and activity in fusion group were p=0.02). There were no statistically significant differences between the groups in these measures, nor in the patients' willingness to have the procedure again. There were no recurrences of prominences or tenderness under the forefoot in either group and no recurrence of severe hallux valgus in the resection group. The arthrodeses healed in 93%. There was no higher risk for clinically relevant IP joint symptoms after arthrodesis. The operating time was significantly longer in the arthrodesis group but this was not linked to a higher wound infection rate.
These results indicate that Mayo resection may still be a good choice for the first MTP joint in total forefoot reconstruction in patients with rheumatoid arthritis.
类风湿关节炎所致的前足疼痛畸形可通过切除较小的跖骨头并结合第一跖趾关节（MTP）的切除或关节融合术进行治疗。
在一项前瞻性随机研究中，我们比较了第一MTP关节融合术与梅奥切除术，作为类风湿关节炎所致前足疼痛畸形患者全前足重建的一部分。所有患者均切除了较小的跖骨头并进行了伸肌腱切断术。31例患者被随机分为关节融合术组或切除术组。
平均随访36（26至52）个月后，切除术组的主观满意度中位数为100分中的96分，关节融合术组为92分。两组根据足部功能指数（FFI）在疼痛、功能障碍和活动方面均有显著改善（除切除术组的功能障碍和融合术组的活动方面p = 0.02外，p <0.001）。这些指标在两组之间无统计学显著差异，患者再次接受该手术的意愿也无差异。两组前足下方均未出现隆起或压痛复发，切除术组也未出现重度拇外翻复发。关节融合术的愈合率为93%。关节融合术后出现临床相关指间关节症状的风险并未更高。关节融合术组的手术时间明显更长，但这与更高的伤口感染率无关。
这些结果表明，在类风湿关节炎患者的全前足重建中，梅奥切除术对于第一MTP关节可能仍是一个不错的选择。
