跖骨颈缩短斜行截骨术治疗类风湿前足畸形的 20 多年随访结果。

More than 20 years' follow-up of metatarsal neck shortening oblique osteotomy for rheumatoid forefoot deformity.

机构信息

Department of Rheumatology, Niigata Rheumatic Center, 1-2-8, Honcho, Shibata City, Niigata 957-0054, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe Miki-cho, Kita-gun, Kagawa 761-0701, Japan.

Department of Rheumatology, Niigata Rheumatic Center, 1-2-8, Honcho, Shibata City, Niigata 957-0054, Japan.

出版信息

J Orthop Sci. 2023 May;28(3):607-613. doi: 10.1016/j.jos.2022.03.005. Epub 2022 Apr 6.

DOI:10.1016/j.jos.2022.03.005

PMID:35396140

Abstract

BACKGROUND

In recent years, advances in pharmacotherapy for rheumatoid arthritis (RA) have dramatically improved the control of disease activity. However, a significant number of patients still develop forefoot deformity. The purpose of this study was to investigate the results of more than 20 years' follow-up of metatarsal neck shortening oblique osteotomy (SOO) for forefoot deformity in patients with RA.

METHODS

The metatarsal neck SOO was performed on 163 feet in 108 patients between January 1985 and December 1996 in the authors' hospital. For the patients, who met the survey criteria, an observational study was performed clinically and radiologically at the baseline and at more than 20 years after surgery.

RESULTS

A retrospective cohort study was conducted on 36 feet in 22 patients, all of whom were female, and the mean age at surgery was 45.6 (35.0-63.0) years old. The follow-up period was 25.1 (21.0-31.0) years. The presence of painful callosities in the surgically treated feet without revised surgeries decreased from 32 feet (100%) to 4 feet (12.5%) at the last follow-up with mild pain that did not cause any footwear problems. Re-osteotomy at the metatarsal of the lessor toe was performed on four feet in two patients. Radiologically, among 128 toes without revised surgeries, 85% were able to have the joint space preserved, and 89% maintained a pain-free condition without any recurrence of deformity. The mean total Japanese Society for Surgery for the Foot (JSSF) RA foot and ankle score was 64.0/100, and the visual analogue scale (VAS) of overall satisfaction was 62 (0: dissatisfied, 100: highly satisfied). The overall satisfaction had a positive correlation with calcaneal pitch and negative correlation with joint space narrowing at the talocrural joint.

CONCLUSIONS

Metatarsal neck SOO appeared to be effective for patients with RA. The deformity was corrected and retained for a long time.

摘要

背景

近年来，类风湿关节炎（RA）的药物治疗进展显著改善了疾病活动的控制。然而，仍有相当数量的患者出现前足畸形。本研究旨在探讨作者医院 1985 年 1 月至 1996 年 12 月期间对 108 例患者的 163 足跖骨颈缩短斜截骨术（SOO）治疗前足畸形的 20 多年随访结果。

方法

对作者医院 1985 年 1 月至 1996 年 12 月期间的 108 例患者的 163 足进行了跖骨颈 SOO。对于符合调查标准的患者，进行了临床和放射学观察研究，在基线和手术后 20 年以上进行。

结果

对 22 例患者的 36 足进行了回顾性队列研究，所有患者均为女性，手术时的平均年龄为 45.6（35.0-63.0）岁。随访时间为 25.1（21.0-31.0）年。在最后一次随访时，未经手术修正的手术治疗足的疼痛性胼胝减少了 32 足（100%）至 4 足（12.5%），仅伴有轻度疼痛，不影响任何鞋类问题。两名患者的第四趾跖骨进行了再次截骨。在未经手术修正的 128 个趾中，85%能够保留关节间隙，89%保持无痛状态，无畸形复发。日本足踝外科协会（JSSF）RA 足踝评分的平均总分为 64.0/100，整体满意度的视觉模拟评分（VAS）为 62（0：不满意，100：非常满意）。整体满意度与跟骨倾斜度呈正相关，与距跟关节关节间隙变窄呈负相关。