Hirao Makoto, Tsuboi Hideki, Akita Shosuke, Matsushita Masato, Ohshima Shiro, Saeki Yukihiko, Hashimoto Jun
Department of Orthopaedics, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Japan.
Department of Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Japan.
SAGE Open Med Case Rep. 2014 Oct 6;2:2050313X14553694. doi: 10.1177/2050313X14553694. eCollection 2014.
We often see painful ankle joint destruction with painful hindfoot valgus deformity in rheumatoid arthritis. Our policy in such cases has been to first correct the hindfoot deformity in the subtalar joint with fusion, but then ankle joint pain has been observed. Two women with rheumatoid arthritis underwent correction and fusion surgery for hindfoot valgus deformity. They had been using wheelchairs because of severe pain in the ankle joint and hindfoot despite extensive medical treatment. After surgery, both patients complained of no pain in the hindfoot. Furthermore, dramatic pain reduction in the ankle joint was also observed especially in a case without ankle joint instability. Consequently, the patients could walk without any support. Correction of valgus hindfoot deformity contributes to centralizing the weight-bearing line in the ankle joint, leading to ankle joint pain relief. It appears possible to preserve the ankle joint without additional ankle surgery even in rheumatoid arthritis cases, if ankle is stable.
我们经常在类风湿性关节炎中看到伴有疼痛性后足外翻畸形的疼痛性踝关节破坏。在这种情况下，我们的策略是首先通过融合术矫正距下关节的后足畸形，但随后会观察到踝关节疼痛。两名患有类风湿性关节炎的女性接受了后足外翻畸形的矫正和融合手术。尽管接受了广泛的药物治疗，但由于踝关节和后足的剧痛，她们一直使用轮椅。手术后，两名患者均称后足无疼痛。此外，尤其在没有踝关节不稳定的病例中，还观察到踝关节疼痛显著减轻。因此，患者无需任何支撑就能行走。矫正后足外翻畸形有助于使踝关节的负重线居中，从而减轻踝关节疼痛。即使在类风湿性关节炎病例中，如果踝关节稳定，似乎也有可能在不进行额外踝关节手术的情况下保留踝关节。
