Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan.
Department of Rehabilitation, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan.
Int J Environ Res Public Health. 2021 Oct 26;18(21):11257. doi: 10.3390/ijerph182111257.
Joint-preserving surgery for the forefoot has been increasingly performed for rheumatoid arthritis (RA). We compared joint-preserving surgeries with resection arthroplasty for RA in the forefoot.
Forefoot surgeries were performed on 62 toes in 42 patients with RA (men: 2; women: 40) between 2002 and 2018. Three groups were compared: PP-31 toes treated with joint-preserving surgery involving the modified Mann method for the big toe and offset osteotomy for lesser toes, PR-15 toes treated with joint-preserving surgery for the big toe and resection arthroplasty for lesser toes, and RR-16 toes treated with resection arthroplasty for all the toes.
The PP group had significantly higher mean scores on a scale for RA in the foot and ankle at the latest follow-up than the RR group (86 vs. 75 points; < 0.05). Hallux valgus (angle > 20°) of the big toe at the latest follow-up recurred in 10 (32%), 9 (60%), and 16 (100%) patients in the PP, PR, and RR groups, respectively. A revision surgery was performed in one patient each in the PP and PR groups.
Joint-preserving surgery is superior to resection arthroplasty in preventing function loss and the recurrence of hallux valgus.
保关节手术在治疗类风湿关节炎（RA）的前足中应用越来越多。我们比较了保关节手术与前足 RA 的关节切除成形术。
2002 年至 2018 年间，对 42 例 RA 患者（男性 2 例，女性 40 例）的 62 个脚趾进行了前足手术。比较了三组手术：PP-31 个脚趾采用改良 Mann 法治疗大脚趾和小脚趾的偏心截骨术进行保关节手术，PR-15 个脚趾采用大脚趾保关节手术和小脚趾关节切除成形术进行治疗，RR-16 个脚趾采用所有脚趾关节切除成形术。
PP 组在最新随访时的足部和踝关节 RA 量表评分明显高于 RR 组（86 分 vs. 75 分；<0.05）。大脚趾拇外翻（角度>20°）在最新随访时分别在 PP、PR 和 RR 组中 10（32%）、9（60%）和 16（100%）例患者中复发。PP 和 PR 组中各有 1 例患者进行了翻修手术。
保关节手术在预防功能丧失和拇外翻复发方面优于关节切除成形术。
