Ozan Firat, Bora Osman Arslan, Filiz Mehmet Ali, Kement Zafer
Department of Orthopedics and Traumatology, Izmir Bozyaka Training and Research Hospital, Izmir.
Acta Orthop Traumatol Turc. 2010;44(2):143-51. doi: 10.3944/AOTT.2010.2243.
We evaluated the outcomes of interposition arthroplasty performed for the treatment of hallux rigidus.
The study included 19 feet (4 left, 15 right) of 17 patients (14 females, 3 males; mean age 61+/-5 years; range 55 to 71 years) who were treated with interposition arthroplasty for hallux rigidus. According to the grading system of Coughlin and Shurnas, 18 feet were grade 3, one foot was grade 4. One-third of the base of the proximal phalanx was resected at surgery. Preoperative and postoperative radiographic assessments included the measurements of the joint space width of the first metatarsophalangeal (MTP) joint, hallux valgus angle, and intermetatarsal angle. Clinical evaluations were made using the AOFAS (American Orthopaedic Foot and Ankle Society) hallux metatarsophalangeal-interphalangeal scale. Postoperative satisfaction levels of the patients were questioned. The mean follow-up period was 21 months (range 9 to 32 months).
According to the AOFAS scale, the results were excellent in seven feet (36.8%), good in nine feet (47.4%), and fair in three feet (15.8%), with excellent and good results accounting for 84.2%. The mean total AOFAS score increased by 24.6 points postoperatively (p<0.05). The mean range of motion of the first MTP joint improved significantly from preoperative 24.2+/-5.4 degrees (range 10 degrees to 30 degrees) to postoperative 54.3+/-9.4 degrees (p<0.05). The mean joint space width of the first MTP joint was 1.0+/-0.3 mm (range 1 to 2 mm) preoperatively, it increased to 3.0+/-1.1 mm (range 1 to 5 mm) on final radiographs (p<0.05). The mean hallux valgus angle decreased from preoperative 13.8 degrees (range 9 degrees to 17 degrees) to postoperative 10.2 degrees (range 4 degrees to 13 degrees), and the mean intermetatarsal angle increased from preoperative 10.5 degrees (range 8 degrees to 14 degrees) to postoperative 11.2 degrees (range 8 degrees to 15 degrees). Patient satisfaction levels were very good in nine feet (47.4%), good in seven feet (36.8%), moderate in one foot (5.3%), and poor in two feet (10.5%). Complications included metatarsalgia aggravated by long walks (n=11, 57.9%), hypoesthesia of the big toe (n=3, 15.8%), and loss of ground contact of the big toe (n=15, 79%). The push-off power of the big toes was measured as 3/5 in five cases, 4/5 in 11 cases, and 5/5 in three cases. None of the patients developed infection or osteonecrosis postoperatively.
Interposition arthroplasty is an appropriate surgical treatment method for hallux rigidus for elderly patients with low functional capacity.
我们评估了用于治疗僵硬性拇趾的间置关节成形术的疗效。
本研究纳入了17例患者（14例女性，3例男性；平均年龄61±5岁；范围55至71岁）的19只足（4只左足，15只右足），这些患者接受了用于治疗僵硬性拇趾的间置关节成形术。根据Coughlin和Shurnas的分级系统，18只足为3级，1只足为4级。手术时切除近节趾骨基底的三分之一。术前和术后的影像学评估包括测量第一跖趾（MTP）关节的关节间隙宽度、拇外翻角和跖间角。使用美国矫形足踝协会（AOFAS）拇趾跖趾-趾间关节评分进行临床评估。询问患者术后的满意度。平均随访期为21个月（范围9至32个月）。
根据AOFAS评分，7只足（36.8%）结果为优，9只足（47.4%）为良，3只足（15.8%）为中，优良结果占84.2%。术后AOFAS总分平均提高了24.6分（p<0.05）。第一MTP关节的平均活动范围从术前的24.2±5.4度（范围10度至30度）显著改善至术后的54.3±9.4度（p<0.05）。第一MTP关节的平均关节间隙宽度术前为1.0±0.3毫米（范围1至2毫米），最终X线片上增加至3.0±1.1毫米（范围1至5毫米）（p<0.05）。平均拇外翻角从术前的13.8度（范围9度至17度）降至术后的10.2度（范围4度至13度），平均跖间角从术前的10.5度（范围8度至14度）增加至术后的11.2度（范围8度至15度）。患者满意度方面，9只足（47.4%）非常好，7只足（36.8%）良好，1只足（5.3%）中等，2只足（10.5%）差。并发症包括长时间行走后加重的跖痛症（n=11，57.9%）、拇趾感觉减退（n=3，15.8%）和拇趾失去与地面接触（n=15，79%）。5例患者的拇趾推离力量测量为3/5，11例为4/5，3例为5/5。所有患者术后均未发生感染或骨坏死。
间置关节成形术是功能能力较低的老年僵硬性拇趾患者的一种合适手术治疗方法。
