Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
Clin Rheumatol. 2013 Dec;32(12):1777-82. doi: 10.1007/s10067-013-2343-y. Epub 2013 Jul 31.
Advanced rheumatoid hindfoot disease causes significant pain and disability. Hindfoot arthrodesis is a useful procedure but is often overlooked as a treatment option. The objective of this study was to report the improvements in patients' health, pain, functional ability and satisfaction following this procedure. Thirty-seven patients with rheumatoid arthritis (RA) were recruited from the outpatient clinic and underwent 42 hindfoot arthrodesis procedures by a single surgeon. Outcome measures were SF12 score, Manchester-Oxford Foot Questionnaire index score, visual analogue pain score and satisfaction scores, as well as radiographic assessment. Assessment was undertaken at the pre-admission clinic and at 6 and 12 months post-operatively. Statistically significant improvements were seen at 6 and 12 months in all measured outcomes. The union rate was 97.6%. The satisfaction rate was 92.5%. The complication rate was 7.1%. The functional benefit and outcome scores are comparable to those reported following hip and knee replacement in patients with RA. The findings of this study provide evidence that hindfoot arthrodesis should be considered a worthwhile surgical treatment in the rheumatoid patient with advanced hindfoot disease. Healthcare professionals involved in the management of these patients should be aware of the potential benefits of this procedure and refer early to a foot and ankle surgeon specialist when conservative treatment modalities have failed.
晚期类风湿性后足疾病会导致严重的疼痛和残疾。后足融合术是一种有效的治疗方法，但常常被忽视。本研究的目的是报告患者在接受该手术后健康、疼痛、功能能力和满意度的改善情况。37 名类风湿关节炎（RA）患者从门诊招募，并由一名外科医生进行了 42 例后足融合术。采用 SF12 评分、曼彻斯特-牛津足部问卷指数评分、视觉模拟疼痛评分和满意度评分以及影像学评估来评估结果。在术前门诊和术后 6 个月和 12 个月进行评估。所有测量结果在 6 个月和 12 个月时均有显著改善。融合率为 97.6%。满意度为 92.5%。并发症发生率为 7.1%。功能获益和结果评分与类风湿关节炎患者髋关节和膝关节置换术的报告结果相当。本研究结果表明，对于晚期后足疾病的类风湿性患者，后足融合术应被视为一种有价值的手术治疗方法。管理这些患者的医疗保健专业人员应该意识到该手术的潜在益处，并在保守治疗失败时尽早向足踝外科医生转诊。
