Vallier G T, Petersen S A, LaGrone M O
Department of Surgery, Letterman Army Medical Center, Presidio of San Francisco, California 94129-6700.
Foot Ankle. 1991 Feb;11(4):187-94. doi: 10.1177/107110079101100401.
The clinical results following Keller resection arthroplasty were reviewed in 54 feet with a 2- to 10-year follow-up. Patients were evaluated by radiographs, physical examination, and questionnaire. The primary indication for surgery was painful hallux valgus with associated degenerative changes of the first metatarsophalangeal joint. Additionally, rheumatoid arthritis was the underlying diagnosis in four feet. Seventy-five percent of all patients had complete relief of their symptoms. There was significant (P less than .01) improvement in both the metatarsophalangeal and intermetatarsal angles, but a decreased range of motion in the first metatarsophalangeal joint, with a complete lack of plantarflexion in 67%. Application of the Bonney and MacNab2 grading system yielded a 72% rate of good and excellent results. The subjective patient satisfaction rate was 87.5%. Patient satisfaction was most strongly associated with the use of a K-wire for postoperative fixation (P = .03), and a limited resection of the proximal phalanx (P = .03). We conclude that the Keller resection arthroplasty is a reasonable alternative for the treatment of hallux valgus in the presence of degenerative changes in the first metatarsophalangeal joint.
对54足行凯勒切除关节成形术的临床结果进行了回顾，随访时间为2至10年。通过X线片、体格检查和问卷调查对患者进行评估。手术的主要指征是伴有第一跖趾关节退行性改变的疼痛性拇外翻。此外，4足的潜在诊断为类风湿性关节炎。所有患者中有75%症状完全缓解。跖趾角和跖间角均有显著改善（P小于0.01），但第一跖趾关节活动度降低，67%的患者完全缺乏跖屈。应用邦尼和麦克纳布2分级系统，优良率为72%。患者主观满意度为87.5%。患者满意度与术后使用克氏针固定（P = 0.03）以及近端趾骨有限切除（P = 0.03）密切相关。我们得出结论，对于存在第一跖趾关节退行性改变的拇外翻治疗，凯勒切除关节成形术是一种合理的选择。
