Tamir Eran, Tamir Jeremy, Beer Yiftah, Kosashvili Yona, Finestone Aharon S
Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Israel Sackler School of Medicine, Tel Aviv University, Israel Maccabi Health Services, Israel.
Susan B. Allen Memorial Hospital, El Dorado, KS, USA.
Foot Ankle Int. 2015 Aug;36(8):969-75. doi: 10.1177/1071100715577952. Epub 2015 Mar 25.
Foot ulcers carry considerable morbidity in patients with peripheral neuropathy and frequently lead to foot amputation. The purpose of this study was to present our experience treating recalcitrant ulcers underlying the hallux interphalangeal joint in patients with diabetes mellitus (DM)-related neuropathy with a first metatarsophalangeal (MTPJ1) resection arthroplasty.
We retrospectively reviewed the computerized medical files of patients with diabetic neuropathy treated with a MTPJ1 resection arthroplasty. We performed 28 arthroplasties on 20 patients with a mean age of 59 years. The patients had a diagnosis of DM for a mean of 10.7 years. Of the ulcers, 26 were grade 1A ulcers, and 2 were grade 2A ulcers (University of Texas score); the ulcer's mean age was 5.4 months. The mean dorsiflexion of the hallux before surgery was 46 degrees.
The primary ulcer recovered in a mean of 3.1 weeks. Major complications (wound dehiscence and infection) occurred in 6 of 28 operations. Patients returned to normal activity 4 weeks after all procedures except in the 6 patients with dehiscence. In a subgroup of patients with follow-up longer than a year, the ulcer recurred after 4 of 18 arthroplasties (22%) between 3 and 12 months due to postoperative hallux rigidus. In the remaining 14 of 18 arthroplasties (78%), there was no recurrence during a mean follow-up of 26 months.
MTPJ1 resection arthroplasty may be considered in a patient with resistant plantar hallux ulcerations, even in the absence of hallux rigidus. As with all operations on neuropathic feet in patients with DM, the surgeon and the patient should be aware that there is a significant likelihood of complications, but most are treatable.
Level IV, case series.
足部溃疡在周围神经病变患者中具有相当高的发病率，并常常导致足部截肢。本研究的目的是介绍我们使用第一跖趾关节（MTPJ1）切除关节成形术治疗糖尿病（DM）相关神经病变患者拇趾间关节下顽固性溃疡的经验。
我们回顾性分析了接受MTPJ1切除关节成形术治疗的糖尿病神经病变患者的电子病历。我们对20名平均年龄为59岁的患者进行了28例关节成形术。患者诊断为DM的平均时间为10.7年。在这些溃疡中，26例为1A 级溃疡，2例为2A级溃疡（德克萨斯大学评分）；溃疡的平均病程为5.4个月。术前拇趾的平均背屈角度为46度。
原发性溃疡平均在3.1周内愈合。28例手术中有6例发生了主要并发症（伤口裂开和感染）。除6例伤口裂开的患者外，所有患者在术后4周恢复正常活动。在随访时间超过一年的患者亚组中，18例关节成形术后有4例（22%）在3至12个月因术后拇趾僵硬导致溃疡复发。在其余14例关节成形术（78%）中，平均随访26个月期间未复发。
即使没有拇趾僵硬，对于难治性跖侧拇趾溃疡患者也可考虑行MTPJ1切除关节成形术。与所有针对DM患者神经病变足部的手术一样，外科医生和患者应意识到存在显著的并发症可能性，但大多数并发症是可治疗的。
IV级，病例系列。
