Kim Paul J, Hatch Daniel, Didomenico Lawrence A, Lee Michael S, Kaczander Bruce, Count Gary, Kravette Marc
Associate Professor, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007-0469, USA.
J Foot Ankle Surg. 2012 Jan-Feb;51(1):50-6. doi: 10.1053/j.jfas.2011.08.009. Epub 2011 Oct 1.
This is a retrospective, multicenter study examining the long-term results for the treatment of end-stage hallux rigidus using 3 different surgical procedures. A total of 158 subjects (105 females and 53 males) were included in the present study. They had undergone 1 of the following surgical procedures: arthrodesis, hemi-implant, or resectional arthroplasty. The long-term results for the subjective assessment of pain, function, and alignment, as well as objective radiographic and physical findings, were examined. The median interval to postoperative follow-up for the 3 procedure groups was 159 weeks. No statistically significant difference was found in age or the number of subjects included in the 3 treatment groups (p = .11 and p = .16, respectively). The body mass index was significantly different statistically among the 3 treatment groups, with the hemi-implant group representing a smaller body mass index compared with the other procedures (p = .007). No statistically significant difference was found in the subjective outcomes among the 3 treatment groups using the American College of Foot and Ankle Surgeons' First Metatarsophalangeal Joint and First Ray Scoring Scale (patient questionnaire) or the modified Hallux Metatarsophalangeal-Interphalangeal Scale of the American Orthopedic Foot and Ankle Society (p = .64 and p = .14, respectively). Furthermore, the correlation coefficient between the 2 subjective scoring scales was 0.78, statistically significant and reflecting a moderate to high correlation (p < .001). The results of the radiographic and clinical evaluation revealed that metatarsalgia was the most common finding for the arthrodesis group (9.8%), bony overgrowth into the joint for the hemi-implant group (28.3%), and floating hallux for the resectional arthroplasty group (30.9%). The results of our study suggest that all 3 surgical procedures are viable options for the treatment of end-stage hallux rigidus.
这是一项回顾性多中心研究，旨在探讨采用3种不同手术方法治疗终末期僵硬性拇趾的长期效果。本研究共纳入158名受试者（105名女性和53名男性）。他们接受了以下手术方法之一：关节融合术、半植入术或切除性关节成形术。对疼痛、功能和对线的主观评估的长期结果，以及客观的影像学和体格检查结果进行了检查。3个手术组术后随访的中位间隔时间为159周。3个治疗组在年龄或纳入的受试者数量上未发现统计学显著差异（分别为p = 0.11和p = 0.16）。3个治疗组的体重指数在统计学上有显著差异，半植入术组的体重指数低于其他手术组（p = 0.007）。使用美国足踝外科医师学会的第一跖趾关节和第一跖骨评分量表（患者问卷）或美国矫形足踝协会改良的拇趾跖趾-趾间量表，3个治疗组在主观结果上未发现统计学显著差异（分别为p = 0.64和p = 0.14）。此外，两个主观评分量表之间的相关系数为0.78，具有统计学显著性，反映出中度至高相关性（p < 0.001）。影像学和临床评估结果显示，关节融合术组最常见的表现是跖痛（9.8%），半植入术组是骨长入关节（28.3%），切除性关节成形术组是拇趾漂浮（30.9%）。我们的研究结果表明，所有这3种手术方法都是治疗终末期僵硬性拇趾的可行选择。
