1st Orthopaedic Clinic, 1st Faculty of Medicine, Charles University in Prague, V Úvalu 84, Prague 5, 150 06, Czech Republic.
BMC Musculoskelet Disord. 2012 Aug 20;13:148. doi: 10.1186/1471-2474-13-148.
Foot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability.
The study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray.
Data of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3%) in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%).
The Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.
足部畸形和前足部相关问题在类风湿关节炎患者中非常常见。内侧楔骨跖骨关节的松弛及其滑膜炎是前足畸形发展的重要因素。受损的关节导致第一跖骨在额状面和矢状面变得不稳定。在这项回顾性研究中，我们评估了接受 Lapidus 手术的类风湿关节炎患者的数据。我们评估了不稳定在一组患者中的作用，主要关注不稳定的临床症状和 X 射线征象。
研究组包括 125 例类风湿关节炎患者。Lapidus 手术的适应证为：前足负重正位 X 线示拇外翻畸形大于 15 度，第一跖骨内翻畸形，跖骨间角大于 15 度。
对 125 例类风湿关节炎患者的 143 例 Lapidus 手术进行了评估，这些患者于 2004 年至 2010 年间接受了手术。在我们的研究组中，92 只脚（64.3%）发现有第一跖骨不稳定的迹象和症状。足部重建前 AOFAS 评分为 48.6，重建后 6 个月为 87.6。X 线显示有 7 只脚（4.9%）的内侧楔骨跖骨关节融合术不愈合。
Lapidus 手术为矫正第一跖骨内翻位置及其不稳定提供了可能，同时为行走提供无痛的足部提供了可能。我们建议在第一跖骨过度活动的无症状类风湿关节炎患者中，将该手术作为预防性手术。
