病灶清除联合伊利扎洛夫技术治疗第一跖趾关节痛风石伴骨缺损
[Lesion clearance combined with Ilizarov technique for treatment of tophi in first metatarsophalangeal joint with bone defect].
作者信息
Qin Boquan, Wu Shizhou, Xie Huiqi, Huang Fuguo, Zhang Hui
机构信息
West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
Laboratory of Stem Cell and Tissue Engineering, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Feb 15;34(2):168-172. doi: 10.7507/1002-1892.201907063.
OBJECTIVE
To evaluate the effectiveness of lesion clearance combined with Ilizarov technique for the treatment of tophi in first metatarsophalangeal (MTP) joint with bone defect.
METHODS
Between July 2016 and June 2018, 14 cases of tophi in the first MTP joint with bone defect were treated by lesion clearance combined with Ilizarov technique. There were 12 males and 2 females. The average age was 39.3 years (range, 22-60 years). The disease duration ranged from 5 to 15 years, with an average of 11.2 years. The tophi volume ranged from 2.5 cm×2.7 cm×2.2 cm to 5.2 cm×2.9 cm×2.4 cm. The X-ray films showed that the length of the bone defect ranged from 2.0 to 4.6 cm, with an average of 3.4 cm. Preoperative visual analogue scale (VAS) score was 7.6±0.9; American Orthopaedic Foot and Ankle Society (AOFAS) score was 47.5±4.3; short-form 36 health survey scale (SF-36) score was 79.7±4.7.
RESULTS
The incision primarily healed in 13 patients after operation. The skin necrosis at the edge of the incision occurred in 1 patient and recovered after symptomatic treatment. All 14 patients were followed up 12-16 months, with an average of 13.6 months. X-ray films showed that the first metatarsal column defects were repaired. The time of bone extension ranged from 2 to 6 weeks, with an average of 3.6 weeks. The time of bone healing ranged from 9 to 16 weeks, with an average of 11.2 weeks. During follow-up, no complication such as nerve, blood vessel, or tendon injury, needle tract infection, or stress fracture occurred. At last follow-up, VAS score was 1.4±0.5, AOFAS score was 86.6±4.8, and SF-36 score was 89.1±3.3, all of which were superior to preoperative scores, with significant differences ( =22.532, =0.000; =22.702, =0.000; =6.124, =0.000).
CONCLUSION
Lesion clearance combined with Ilizarov technique is a safe and effective method for the treatment of tophi in the first MTP joint with bone defect.
目的
评估病灶清除联合伊利扎罗夫技术治疗第一跖趾关节痛风石伴骨缺损的疗效。
方法
2016年7月至2018年6月，对14例第一跖趾关节痛风石伴骨缺损患者采用病灶清除联合伊利扎罗夫技术治疗。其中男性12例，女性2例。平均年龄39.3岁（范围22 - 60岁）。病程5至15年，平均11.2年。痛风石体积为2.5 cm×2.7 cm×2.2 cm至5.2 cm×2.9 cm×2.4 cm。X线片显示骨缺损长度为2.0至4.6 cm，平均3.4 cm。术前视觉模拟评分（VAS）为7.6±0.9；美国足踝外科协会（AOFAS）评分为47.5±4.3；健康调查简表（SF - 36）评分为79.7±4.7。
结果
13例患者术后切口一期愈合。1例患者切口边缘皮肤坏死，经对症治疗后恢复。14例患者均获随访，时间为12至16个月，平均13.6个月。X线片显示第一跖骨柱缺损修复。骨延长时间为2至6周，平均3.6周。骨愈合时间为9至16周，平均11.2周。随访期间未发生神经、血管、肌腱损伤、针道感染或应力性骨折等并发症。末次随访时，VAS评分为1.4±0.5，AOFAS评分为86.6±4.8，SF - 36评分为89.1±3.3，均优于术前评分，差异有统计学意义（=22.532，=0.000；=22.702，=0.000；=6.124，=0.000）。
结论
病灶清除联合伊利扎罗夫技术是治疗第一跖趾关节痛风石伴骨缺损的一种安全有效的方法。
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