日本患者类风湿性关节炎的全踝关节置换术：中长期随访的回顾性研究
Total Ankle Arthroplasty for Rheumatoid Arthritis in Japanese Patients: A Retrospective Study of Intermediate to Long-Term Follow-up.
作者信息
Hirao Makoto, Hashimoto Jun, Tsuboi Hideki, Ebina Kosuke, Nampei Akihide, Noguchi Takaaki, Tsuji Shigeyoshi, Nishimoto Norihiro, Yoshikawa Hideki
机构信息
Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.
出版信息
JB JS Open Access. 2017 Nov 28;2(4):e0033. doi: 10.2106/JBJS.OA.17.00033. eCollection 2017 Dec 28.
BACKGROUND
Outcomes after total ankle arthroplasty (TAA) combined with additive techniques (augmentation of bone strength, control of soft-tissue balance, adjustment of the loading axis) for the treatment of rheumatoid arthritis were evaluated after intermediate to long-term follow-up. The influences of biologic treatment on the outcomes after TAA were also evaluated.
METHODS
We performed a retrospective observational study involving 50 ankles (44 patients) that underwent TAA for the treatment of rheumatoid arthritis. The mean duration of follow-up was 7.1 years. Clinical outcomes were evaluated with use of the Japanese Society for Surgery of the Foot (JSSF) scale score and a postoperative self-administered foot-evaluation questionnaire (SAFE-Q). Radiographic findings were evaluated as well. These parameters also were compared between patients managed with and without biologic treatment.
RESULTS
This procedure significantly improved the clinical scores of the JSSF rheumatoid arthritis foot and ankle scale (p < 0.0001). Forty-eight of the 50 ankles had no revision TAA surgery. Subsidence of the talar component was seen in 8 ankles (6 in the biologic treatment group and 2 in the non-biologic treatment group); 2 of these ankles (both in the biologic treatment group) underwent revision TAA. The social functioning score of the SAFE-Q scale at the time of the latest follow-up was significantly higher in the biologic treatment group (p = 0.0079). The dosage of prednisolone (p = 0.0003), rate of usage of prednisolone (p = 0.0001), and disease-activity score (p < 0.01) at the time of the latest follow-up were all significantly lower in the biologic treatment group.
CONCLUSIONS
TAA is recommended for the treatment of rheumatoid arthritis if disease control, augmentation of bone strength, control of soft-tissue balance, and adjustment of the loading axis are taken into account. The prevention of talar component subsidence remains a challenge in patients with the combination of subtalar fusion, rheumatoid arthritis, and higher social activity levels.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
对全踝关节置换术（TAA）联合增强技术（增强骨强度、控制软组织平衡、调整负重轴）治疗类风湿关节炎的中期至长期随访结果进行评估。同时评估生物治疗对TAA术后结果的影响。
方法
我们进行了一项回顾性观察研究，纳入50例（44例患者）接受TAA治疗类风湿关节炎的踝关节。平均随访时间为7.1年。采用日本足外科学会（JSSF）量表评分和术后自我管理足部评估问卷（SAFE-Q）评估临床结果。同时也对影像学结果进行评估。对接受和未接受生物治疗的患者的这些参数进行比较。
结果
该手术显著改善了JSSF类风湿关节炎足踝关节量表的临床评分（p < 0.0001）。50例踝关节中有48例未进行TAA翻修手术。8例踝关节出现距骨假体下沉（生物治疗组6例，非生物治疗组2例）；其中2例踝关节（均在生物治疗组）接受了TAA翻修手术。在最近一次随访时，生物治疗组SAFE-Q量表的社会功能评分显著更高（p = 0.0079）。生物治疗组在最近一次随访时的泼尼松龙剂量（p = 0.0003）、泼尼松龙使用率（p = 0.0001）和疾病活动评分（p < 0.01）均显著更低。
结论
如果考虑疾病控制、增强骨强度、控制软组织平衡和调整负重轴，推荐TAA用于治疗类风湿关节炎。对于合并距下关节融合、类风湿关节炎且社会活动水平较高的患者，预防距骨假体下沉仍然是一项挑战。
证据水平
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
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