关节切开术治疗僵硬拇趾的长期随访。
Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus.
机构信息
Rothman Orthopaedic Institute, Philadelphia, PA, USA.
Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
出版信息
Foot Ankle Int. 2019 Oct;40(10):1114-1121. doi: 10.1177/1071100719859236. Epub 2019 Jul 16.
BACKGROUND
Hallux rigidus is the most common arthritic condition in the foot. First metatarsophalangeal joint cheilectomy produces satisfactory results in retrospective studies with reported good to excellent results in up to 97% and pain relief and function in 92%. The results of cheilectomy for higher grades of hallux rigidus are less favorable. The purpose of this study was to evaluate the long-term functional results and survivorship of cheilectomy for treatment of hallux rigidus.
METHODS
This was a retrospective, questionnaire-based study investigating the long-term results of cheilectomy for treatment of hallux rigidus. The preoperative arthritic grade was graded retrospectively according to the Hattrup and Johnson (H&J) grading system. A questionnaire was administered via email or telephone that included questions regarding pain recurrence following surgery, current functional status, and satisfaction with the operation. Kaplan-Meier survival analysis was performed to estimate survival time between arthritic grades. We reviewed 165 patients (169 feet) with an average follow-up of 6.6 (5.0-10.9) years.
RESULTS
The overall survival rate (painless at the time of last follow-up) was 70.4% (119 feet), with no significant difference between the 3 H&J arthritic grades. Most of the recurrences (28 feet, 75%) were at the first 2 years following the surgery. Nine feet (5.3%) had a second procedure at a mean postoperative time of 3.6 (range, 1.6-7.4) years. Of the 169 feet, 117 (69.3%) reported being satisfied or very satisfied and 127 (75.1%) indicated they would repeat the operation under the same circumstances.
CONCLUSION
Our study supports the use of cheilectomy for treatment of hallux rigidus (grade 1-3 Coughlin and Shurnas) as a reliable procedure with favorable results. At long-term follow-up, patients who underwent cheilectomy had a low revision rate and a moderately low rate of pain recurrence.
LEVEL OF EVIDENCE
Level IV, retrospective case-series.
背景
拇僵硬是足部最常见的关节炎。第一跖趾关节切除术在回顾性研究中取得了满意的结果，报告的优良率高达 97%，疼痛缓解率和功能恢复率为 92%。对于更高等级的拇僵硬，切除术的结果则不太理想。本研究的目的是评估拇僵硬切除术治疗的长期功能结果和存活率。
方法
这是一项回顾性、基于问卷调查的研究，调查了拇僵硬切除术治疗的长期结果。根据 Hattrup 和 Johnson（H&J）分级系统，对术前关节炎分级进行回顾性分级。通过电子邮件或电话进行问卷调查，内容包括手术后疼痛复发、当前功能状况和对手术的满意度。采用 Kaplan-Meier 生存分析估计关节炎分级之间的生存时间。我们回顾了 165 例（169 足）患者，平均随访 6.6（5.0-10.9）年。
结果
总的存活率（最后随访时无痛）为 70.4%（119 足），3 个 H&J 关节炎分级之间无显著差异。大多数复发（28 足，75%）发生在手术后的前 2 年。9 足（5.3%）在术后 3.6 年（范围 1.6-7.4 年）进行了第二次手术。在 169 足中，117 足（69.3%）报告满意或非常满意，127 足（75.1%）表示在相同情况下会再次接受手术。
结论
我们的研究支持使用切除术治疗拇僵硬（Coughlin 和 Shurnas 分级 1-3），这是一种可靠的手术方法，效果良好。在长期随访中，接受切除术的患者翻修率较低，疼痛复发率也较低。
证据等级
IV 级，回顾性病例系列。
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