Coughlin Michael J, Grebing Brett R, Jones Carroll P
Idaho Foot and Ankle Fellowship Program, Boise.ID, 83706, USA.
Foot Ankle Int. 2005 Oct;26(10):783-92. doi: 10.1177/107110070502601001.
Followup studies documenting the outcome of primary metatarsophalangeal (MTP) joint arthrodesis for treatment of hallux valgus deformities are rare. The purpose of this report was to evaluate the results of first MTP joint arthrodesis as treatment for moderate and severe hallux valgus deformities over a 22-year period in a single surgeon's practice.
All living patients treated between 1979 and 2001, for moderate and severe idiopathic hallux valgus deformities with first MTP joint arthrodesis were contacted and asked to return for a followup examination. Outcomes were assessed by comparing preoperative and postoperative pain, function, and radiographic appearance. First ray mobility and ligamentous laxity also were assessed postoperatively.
Eighteen of 21 of the first MTP joints had successfully fused with the primary procedure at an average followup of 8.2 years (range 24 to 271 months). The time to union averaged 10 (range 7 to 15) weeks. Two of the three nonunions, both in the same patient, were asymptomatic and were not revised. One required a revision to achieve fusion. The average corrections in the hallux valgus angle and 1-2 intermetatarsal (IM) angle were 21 degrees and 6 degrees, respectively, and the average postoperative dorsiflexion angle was 22 degrees. Subjective satisfaction was rated as excellent in seventeen of 21 cases (80%) and good in the remaining four (20%). There was significant reduction in postoperative pain (p < 0.001), complete resolution of lateral metatarsalgia, and the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores averaged 84 (range 72 to 90) at final followup. Major activity restrictions after surgery were uncommon, and all patients were able to wear conventional or comfort shoes. Interphalangeal (IP) joint arthritis progressed in seven of 21 feet (33%), but all of these changes were mild.
In the present study, arthrodesis of the first MTP joint for idiopathic hallux valgus resulted in a high percentage of successful results at an average followup of over 8 years.
记录原发性跖趾（MTP）关节融合术治疗拇外翻畸形疗效的随访研究较少。本报告的目的是评估在一位外科医生22年的临床实践中，首例MTP关节融合术治疗中重度拇外翻畸形的效果。
联系了1979年至2001年间所有接受首例MTP关节融合术治疗中重度特发性拇外翻畸形且仍在世的患者，并要求他们回来进行随访检查。通过比较术前和术后的疼痛、功能及影像学表现来评估疗效。术后还评估了第一跖骨的活动度和韧带松弛情况。
21例中的18例首例MTP关节在初次手术后成功融合，平均随访8.2年（范围24至271个月）。愈合时间平均为10周（范围7至15周）。3例未愈合患者中有2例（在同一患者）无症状且未进行翻修。1例需要翻修以实现融合。拇外翻角度和第1、2跖骨间（IM）角的平均矫正分别为21度和6度，术后平均背屈角度为22度。21例中有17例（80%）主观满意度评为优秀，其余4例（20%）评为良好。术后疼痛显著减轻（p < 0.001），外侧跖痛症完全缓解，末次随访时术后美国矫形足踝协会（AOFAS）评分平均为84分（范围72至90分）。术后主要活动受限情况不常见，所有患者都能穿常规或舒适的鞋子。21只脚中有7只（33%）的趾间（IP）关节出现关节炎进展，但所有这些变化都很轻微。
在本研究中，特发性拇外翻的首例MTP关节融合术在平均超过8年的随访中取得了较高的成功率。
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