[类风湿关节炎患者的拉皮德斯手术——短期结果]

[Lapidus procedure in patients with rheumatoid arthritis--short-term results].

作者信息

Popelka S, Vavrík P, Hromádka R, Sosna A

机构信息

Department of Orthopaedic Surgery, Motol Teaching Hospital, Prague, Czech Republic.

出版信息

Z Orthop Unfall. 2008 Jan-Feb;146(1):80-5. doi: 10.1055/s-2007-989439.

DOI:10.1055/s-2007-989439

PMID:18324587

Abstract

AIM

Hallux valgus combined with flat foot is one of the most common foot deformities affecting patients with rheumatoid arthritis. The Lapidus procedure is indicated when the hallux valgus angle is more than 15 degrees or the first tarsometatarsal joint is hypermobile. We aimed to evaluate the results of the Lapidus procedure in patients with rheumatoid arthritis.

METHOD

We performed the Lapidus procedure in 31 patients between 2002 and 2005. In ten patients we performed a bilateral procedure and in ten patients we performed a single Lapidus procedure. In 27 cases we combined the procedure with a resection of the second-fifth metatarsal heads (Hoffmann procedure), in four cases with a Weil osteotomy of the second-fifth metatarsal necks. We performed an excision of the articular surface of the first metatarsal head (Mayo) in 10 patients, a Keller resection procedure in 9 patients, an arthrodesis of the first metatarsophalangeal joint in 3 patients, and an Akin wedge osteotomy of the proximal phalanx of the thumb in 3 patients. Arthrodesis was fixed by two K-wires in 5 cases, by 2 compression screws in 7 cases, and in thirty-four cases we used memory staples.

RESULTS

We evaluated the outcomes of forty-one procedures in thirty-one patients (24 female, 7 male). The averge age at surgery was 54.3 years. Thirty-two feet were without pain after the procedures, in five cases the patients felt moderate pain in the dorsal part of the foot and in four cases the patients felt pain in the transverse arch of foot. Complications included delayed primary wound closure in five cases, in one case we performed a revision procedure for a deep infection. Delayed hallux valgus developed in 5 cases. The mean first intermetatarsal angle before surgery was 19.5 degrees (range 12 - 27 degrees) and improved to 8 degrees after surgery. In 3 cases we found an unsatisfactory intermetatarsal angle correction with partial renewal of the hallux valgus.

CONCLUSION

A correctly performed Lapidus procedure enables correction of the varus position of 1st metatarsus and hallux valgus.

摘要

目的

拇外翻合并扁平足是类风湿性关节炎患者中最常见的足部畸形之一。当拇外翻角度大于15度或第一跖跗关节活动度过大时，可采用拉皮德斯手术。我们旨在评估拉皮德斯手术治疗类风湿性关节炎患者的效果。

方法

2002年至2005年间，我们对31例患者实施了拉皮德斯手术。其中10例患者接受了双侧手术，10例患者接受了单侧拉皮德斯手术。27例患者在手术中联合切除了第二至第五跖骨头（霍夫曼手术），4例患者联合进行了第二至第五跖骨颈的韦尔截骨术。10例患者进行了第一跖骨头关节面切除（梅奥手术），9例患者进行了凯勒切除术，3例患者进行了第一跖趾关节融合术，3例患者进行了拇指近节趾骨的埃金楔形截骨术。5例患者的关节融合术用两根克氏针固定，7例患者用2枚加压螺钉固定，34例患者使用了记忆钉。

结果

我们评估了31例患者（24例女性，7例男性）的41次手术结果。手术时的平均年龄为54.3岁。术后32只脚无疼痛，5例患者足部背侧有中度疼痛，4例患者足横弓疼痛。并发症包括5例原发性伤口延迟愈合，1例因深部感染进行了翻修手术。术后出现5例拇外翻复发。术前第一跖骨间平均角度为19.5度（范围12 - 27度），术后改善至8度。3例患者的跖骨间角度矫正效果不理想，拇外翻部分复发。