Takenouchi Kenji, Morishita Minoru, Saitoh Kimihisa, Wauke Kouichi, Takahashi Hiroshi, Nagashima Masakazu
Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School.
J Nippon Med Sch. 2009 Oct;76(5):240-6. doi: 10.1272/jnms.76.240.
We report herein the results of a retrospective study of 30 ankle arthrodesis procedures performed in 27 patients with rheumatoid arthritis from 1994 through 2001 using a novel design of intramedullary nail with fins. The surgical treatment, post-operative management and clinical evaluation are described. The clinical evaluation, at an average follow-up period of more than 10 years, was based on foot disease scores from the Japanese Orthopaedic Association and scores obtained preoperatively, postoperatively, and during follow-ups 1 (November 2001) and 2 (November 2007) were compared. These variables showed significant improvement between before surgery and at follow-up evaluations. Non-union was not observed and no marked changes of the Chopart joint were seen between before surgery and at follow-up evaluations. Delayed wound healing was seen in 9 of 30 joints. However, infection neuropathy or other complications were not found. We conclude that arthrodesis using an intramedullary nail with fins is an effective treatment for severe hindfoot deformities in patients with rheumatoid arthritis because no cases of non-union were observed and because clinical results over the mean 10-year follow-up period were good or satisfactory.
我们在此报告一项回顾性研究的结果，该研究对1994年至2001年间27例类风湿性关节炎患者实施的30例踝关节融合手术进行了分析，手术采用了一种新型带鳍髓内钉设计。文中描述了手术治疗、术后管理及临床评估情况。平均随访期超过10年的临床评估基于日本骨科协会的足部疾病评分，并对术前、术后以及随访1期（2001年11月）和随访2期（2007年11月）所获得的评分进行了比较。这些变量在术前和随访评估之间显示出显著改善。未观察到骨不连情况，术前和随访评估之间也未发现Chopart关节有明显变化。30个关节中有9个出现伤口愈合延迟。然而，未发现感染、神经病变或其他并发症。我们得出结论，使用带鳍髓内钉进行关节融合术是治疗类风湿性关节炎患者严重后足畸形的有效方法，因为未观察到骨不连病例，且在平均10年的随访期内临床结果良好或令人满意。
