Triolo Pierfranco, Rosso Federica, Rossi Roberto, Cerlon Raul, Cottino Umberto, Bonasia Davide Edoardo
Orthopedics Surgeon, First Department of Orthopaedics and Traumatology, University of Torino, CTO Hospital, Torino, Italy.
Professor of Orthopedic Surgery, Department of Orthopaedics and Traumatology, University of Torino, AO Ordine Mauriziano Hospital, Torino, Italy.
J Foot Ankle Surg. 2017 Mar-Apr;56(2):263-270. doi: 10.1053/j.jfas.2016.11.008. Epub 2017 Jan 7.
The goals of the present study were to evaluate the mid-term results of first metatarsophalangeal joint fusion combined with second to fifth metatarsal head resection in rheumatoid forefoot deformity and identify the prognostic factors. The inclusion criteria were 2010 American College of Rheumatology and/or European League Against Rheumatism criteria for rheumatoid arthritis; symptomatic forefoot deformity; first metatarsophalangeal joint fusion and second to fifth metatarsal head resection; and a minimum of 4 years of follow-up data available. The patients were evaluated using the Disease Activity Score 28 for rheumatoid arthritis, Health Assessment Questionnaire for Rheumatoid Arthritis, Foot Function Index, forefoot American Orthopaedic Foot and Ankle Society scale, and weightbearing radiographs. Different pre-, intra-, and postoperative variables were investigated to identify the prognostic factors. Sixty-two patients (89 feet) with a mean age of 60.8°± 9.4 years and 85.5°± 22.4 months of follow-up data were included. The preoperative American Orthopaedic Foot and Ankle Society scale score was 33.4 ± 16 points and improved significantly (p < .001) after surgery (mean 82.9 ± 11.7 points). The mean Foot Function Index improved significantly (p < .001) from 131.6 ± 37.4 to 77.4 ± 46.3 points at the last follow-up visit. Only the revision surgery variable was significantly (p = .02) related to poor outcomes. Revision was necessary in 8 feet (9%). This procedure produced satisfactory results. Poor outcomes were significantly related to the necessity for revision surgery for nonunion, malunion, inadequate metatarsal resection, and painful hardware.
本研究的目的是评估类风湿性前足畸形中第一跖趾关节融合术联合第二至第五跖骨头切除术的中期结果，并确定预后因素。纳入标准为2010年美国风湿病学会和/或欧洲抗风湿病联盟的类风湿性关节炎标准；有症状的前足畸形；第一跖趾关节融合术和第二至第五跖骨头切除术；以及至少有4年的随访数据。使用类风湿性关节炎疾病活动评分28、类风湿性关节炎健康评估问卷、足部功能指数、前足美国矫形足踝协会量表和负重X线片对患者进行评估。研究了不同的术前、术中和术后变量以确定预后因素。纳入了62例患者（89只足），平均年龄为60.8°±9.4岁，随访数据为85.5°±22.4个月。术前美国矫形足踝协会量表评分为33.4±16分，术后显著改善（p<0.001）（平均82.9±11.7分）。最后一次随访时，平均足部功能指数从131.6±37.4分显著改善（p<0.001）至77.4±46.3分。只有翻修手术变量与不良结果显著相关（p=0.02）。8只足（9%）需要翻修。该手术产生了满意的结果。不良结果与因骨不连、骨愈合不良、跖骨切除不足和内固定疼痛而进行翻修手术的必要性显著相关。
