人工跖趾关节置换术临床应用初步报告

Preliminary experience of metatarsophalangeal arthroplasty with silicon Swanson prosthesis

目的探讨人工跖趾关节置换术治疗跖趾关节骨性关节炎、类风湿性关节炎、!僵硬及跖骨头缺血性坏死的近期疗效。方法2002年3月至2005年3月,应用带金属垫圈的Swanson可屈曲铰链式趾关节假体实施人工跖趾关节置换手术共30例47趾,男11例16趾,女19例31趾;年龄33￣77岁,平均62.5岁;双侧15例31趾。类风湿性关节炎7趾,!僵硬5趾,!外翻畸形伴严重骨性关节炎21趾,第二跖骨头坏死6趾,跖趾关节陈旧性脱位6趾,!外翻术后2趾。第一跖趾关节33趾,第二跖趾关节11趾,第三跖趾关节2趾,第四跖趾关节1趾。2例患者(4趾),第一、二跖骨间角为19°￣20°,平均为19.5°,同时行第一跖骨基底截骨,Biofix可吸收拉力螺钉内固定术。另2例类风湿性关节炎患者(3趾),同时行第二至五跖骨头切除术。采用美国足踝外科协会Maryland跖趾关节百分评分系统,对疼痛、功能、客观体征进行评分。结果29例(46趾)获得随访,随访时间3￣36个月,平均26.5个月。Maryland评分术前为55￣82分,平均72分;术后为67￣96分,平均91分。优41趾(89.13%),良2趾(4.35%),可2趾(4.35%),差1趾(2.17%),手术优良率为93.48%。术后发生伤口延迟愈合2趾,假体脱位1趾,反应性滑膜炎1趾。除假体脱位1趾采用手术取出假体外,其余3趾均保守治疗,效果满意。结论人工跖趾关节置换术治疗严重的跖趾关节骨性关节炎、类风湿性关节炎、跖趾关节陈旧性脱位、!僵硬及跖骨头缺血性坏死的近期疗效较好,优良率高。

Objective To evaluate the short-term results of total metatarsophalangeal arthroplasty （TMPA） for OA, RA, hallux valgus with severe OA, hallux rigidus, and osteonecrosis of metatarsal heads. Methods From March 2002 to March 2005, total metatarsophalangeal arthroplasty was performed in 30 patients （11 males and 19 females, age from 33 to 77 years old, average 62.5 years old） and 47 feet. Fifteen were bilateral. The preoperative underlying diagnosis was RA in 7, hallux rigidus in 5, hallux valgus with severe OA in 21, avascular osteonecrosis in second metatarsal head in 6, old metatarsophalangeal dislocation in 2, complications after McBride operation in 2 feet. Totally, 33 first metatarsoplangeal joints, 11 second metatarsephalangeal joints, 2 third metatarsophalangeal joints and 1 fourth metatarsophalangeal joint were replaced with metal bushed silicon Swanson prostheses. Two patients （4 feet） with abnormal first-second in- termetetarsal angle （19°-20°） received simultaneous proximal metatarsal osteotomy. The osteotomed metatarsal were fixed with Biofix absorbable screws. Two patients （3 feet） received simultaneous metatarsal head （2-5） resection arthroplasty. Twenty-nine （46 feet） were followed-up for average 26.5 （3-36） months with Maryland metatarsal joint scoring system. Oriented by the Maryland scoring system, pain, joint function, and objective messurements were recorded and scored. Results The preoperative and postoperatvie Mary- land score was 72 （55-82） and 91 （67-96）, respectively. Excellent result was achieved in 41 feet （89.13%）, good in 2 feet（4.35%）, fair in 2 feet（4.35%）, and poor in 1 foot（2.17%）. The good-excellent result rate in this group was 93.48%. The complications included： delayed wound union in 2 feet, implant dislocation in 1 foot, reactive synovitis in 1 foot. Conclusion The short-term result of total metatarsophalangeal arthroplasty for treatment of OA, RA, hallux rigidus, old dislocation of metatarsophalangeal and avascular osteonecrosis of metatarsal heads is satisfying.