Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands.
Foot Ankle Surg. 2010 Sep;16(3):117-21. doi: 10.1016/j.fas.2009.07.001. Epub 2009 Aug 22.
The standard procedure when operating on the rheumatoid forefoot is resection arthroplasty of the metatarsophalangeal joints of the lesser rays. Good clinical results (with a follow-up of over 10 years) have been reported when this technique is used. Another technique is repositioning of the metatarsophalangeal subluxation or dislocation of the lesser rays.
To assess the results of forefoot reconstruction using the repositioning technique performed in 54 feet (39 patients) by one surgeon using this technique.
39 RA patients (15 bilateral, 54 feet) were treated with the technique of repositioning the metatarsophalangeal subluxation or dislocation. All surgery was performed by one orthopaedic surgeon. In case of severe deformity or degeneration of the metatarsophalangeal joint of the hallux, an arthrodesis was performed. All patients were reviewed after a mean follow-up of 40 months (range 12-72 months) and an American Orthopaedic Foot and Ankle Society (AOFAS) foot score, and Foot Function Index (FFI) were obtained.
When, in addition to repositioning the metatarsophalangeal joints, an arthrodesis of the hallux was performed, the mean AOFAS-forefoot score was 69.80 (SD=11.8) at a mean of 40 months (SD=15.6 months) postoperatively. In cases with no operation on the hallux, the AOFAS score was 42.2 (SD=18.8) (p=0.001). The postoperative FFI-scores were 23.0 (SD=17.5) and 43.9 (SD=14.6) respectively (p=0.026). When comparing the patients who were satisfied (satisfaction VAS>7) and those who were not, the most important factor was also fusion of the first metatarsophalangeal (MPJ) joint, without a fusion only 50% was satisfied, with a fusion the satisfaction rate was 93%. In four patients a recurrence of the deformity of one of the lesser rays developed, for which a re-operation has been performed.
Reconstruction of the rheumatoid forefoot by repositioning the metatarsophalangeal joints of the lesser rays, thereby preserving the joints, can be considered as a procedure that provides improvement in the clinical outcome. Best results were seen in patients in whom, in addition to reconstruction of the lesser rays, an arthrodesis of the hallux was performed.
类风湿性前足手术的标准程序是切除较小的跖趾关节的关节成形术。当使用这种技术时，已经报道了良好的临床结果（随访时间超过 10 年）。另一种技术是重新定位较小的跖趾关节半脱位或脱位。
评估一位外科医生使用重新定位技术对 54 只脚（39 例）进行前足重建的结果，该技术由一位外科医生使用。
39 例 RA 患者（15 例双侧，54 只脚）采用重新定位较小跖趾关节半脱位或脱位的技术进行治疗。所有手术均由一位骨科医生完成。如果大脚趾的跖趾关节严重畸形或退化，则进行融合术。所有患者平均随访 40 个月（12-72 个月）后进行复查，获得美国矫形足踝协会（AOFAS）足部评分和足部功能指数（FFI）。
除了重新定位跖趾关节外，如果同时对大脚趾进行融合术，术后平均 40 个月（SD=15.6 个月）时 AOFAS 前足评分平均为 69.80（SD=11.8）。如果大脚趾没有手术，AOFAS 评分为 42.2（SD=18.8）（p=0.001）。术后 FFI 评分分别为 23.0（SD=17.5）和 43.9（SD=14.6）（p=0.026）。比较满意（VAS 评分>7）和不满意的患者，最重要的因素也是第一跖趾关节（MPJ）的融合，如果没有融合，只有 50%的患者满意，融合后满意度为 93%。有 4 例较小跖骨之一的畸形复发，已进行再次手术。
通过重新定位较小的跖趾关节来重建类风湿性前足，从而保留关节，可以被认为是一种提供临床结果改善的手术。在除了重建较小的跖骨外，还对大脚趾进行融合的患者中，效果最佳。
