Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan.
Mod Rheumatol. 2013 Jul;23(4):774-81. doi: 10.1007/s10165-012-0739-1. Epub 2012 Aug 29.
The purpose of this study is to compare the anatomy of rheumatoid hallux valgus with that of idiopathic hallux valgus from the standpoint of joint-preserving surgery.
One hundred forty-eight feet of 81 rheumatoid patients were included. Feet with idiopathic hallux valgus and normal feet were compared as controls. Weight-bearing dorsoplantar radiographs of the feet were taken of each patient. A two-dimensional coordinate system was defined on the radiographic image, and 19 anatomic points of the forefoot were measured.
In rheumatoid hallux valgus, the first metatarsal head shifted medially as hallux valgus angle increased, which was similar to the deformity of idiopathic hallux valgus. Proximal deviation of the tips of the lesser toes, caused by clawing and dislocations of the metatarsophalangeal joints, occurred in rheumatoid hallux valgus. Specifically the tips of the second toes in rheumatoid hallux valgus were located more proximally than those in idiopathic hallux valgus irrespective of the severity of hallux valgus.
Corrective osteotomy of the first metatarsal is a reasonable procedure for rheumatoid hallux valgus. Additionally, correction of the second toe deformity to make a stable lateral support on the hallux may be another important factor for successful joint-preserving surgery.
本研究旨在从保留关节手术的角度比较类风湿性踇外翻与特发性踇外翻的解剖结构。
纳入 81 例类风湿性患者的 148 只脚。将特发性踇外翻和正常足作为对照组进行比较。对每位患者的足部进行负重前后位 X 线检查。在 X 线图像上定义二维坐标系，并测量前足的 19 个解剖点。
在类风湿性踇外翻中，随着踇外翻角度的增加，第一跖骨头向内侧移位，与特发性踇外翻的畸形相似。由于跖趾关节的爪状和脱位，小趾的末端发生近侧偏斜。具体而言，类风湿性踇外翻中第二趾的末端比特发性踇外翻更靠近近端，而与踇外翻的严重程度无关。
第一跖骨的矫正性截骨术是治疗类风湿性踇外翻的合理方法。此外，纠正第二趾畸形以在踇趾上形成稳定的外侧支撑可能是保留关节手术成功的另一个重要因素。
