Department of Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Mod Rheumatol. 2021 Mar;31(2):380-385. doi: 10.1080/14397595.2020.1775960. Epub 2020 Jun 16.
Delayed wound healing is one of the most common complications following forefoot surgery in patients with rheumatoid arthritis. We aimed to identify the risk factors for delayed wound healing following rheumatoid forefoot surgery.
Consecutive patients who underwent primary rheumatoid forefoot surgery (86 feet; 53 patients) between April 2008 and February 2019 were retrospectively evaluated. Clinical data, including smoking history, duration of the disease, presence of diabetes mellitus, medication, white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein, the surgical procedure performed, and the Japanese Society for Surgery of the Foot (JSSF) scores, were collected.
Delayed wound healing was identified in 20 of 86 (23.3%) feet. In univariate analysis, participants showing delayed healing were older at the time of surgery ( = .04), their ESR was higher ( = .0006), and their total ( = .019) and pain ( = .016) scores on the JSSF Lesser toe scale were lower than those showing normal healing. In multivariable analysis, both the total preoperative JSSF Lesser toe scale score ( = .0239) and ESR ( = .0126) remained significant risk factors for delayed wound healing.
After rheumatoid forefoot surgery, surgeons should pay more attention to wound care in patients with lower preoperative JSSF Lesser toe score and high ESR.
类风湿关节炎患者行前足手术后，伤口愈合延迟是最常见的并发症之一。本研究旨在确定类风湿前足手术后伤口愈合延迟的相关风险因素。
回顾性分析 2008 年 4 月至 2019 年 2 月期间接受初次类风湿前足手术的连续患者（86 足；53 例患者）的临床资料。收集的临床资料包括吸烟史、疾病持续时间、糖尿病、药物治疗、白细胞计数、红细胞沉降率（ESR）、C 反应蛋白、手术方式、日本足外科协会（JSSF）评分等。
86 足中 20 足（23.3%）出现伤口愈合延迟。单因素分析显示，愈合延迟组的手术时年龄较大（ = .04），ESR 较高（ = .0006），JSSF 小趾评分的总分（ = .019）和疼痛评分（ = .016）均低于正常愈合组。多因素分析显示，术前 JSSF 小趾评分总分（ = .0239）和 ESR（ = .0126）均为伤口愈合延迟的独立危险因素。
行类风湿前足手术后，对于术前 JSSF 小趾评分较低和 ESR 较高的患者，外科医生应更加注意伤口护理。
