类风湿足跖趾关节硅橡胶假体置换术

The results of first metatarsophalangeal joint arthroplasty in six RA patients with flexible silicone prostheses

目的临床观察用硅橡胶假体置换第一跖趾关节矫正类风湿性关节炎(rheumatoidarthritis,RA)前足畸形的疗效。方法2年间对6例RA患者共11个第一跖趾关节行假体置换术。其中男1例 ,女5例 ;随访38～59个月 ,平均49.75个月。术前外翻30°～75° ,平均45.6°;跖内翻10°～25° ,平均16°;关节活动幅度13°～45° ,平均32.5°。结果术后外翻15°～36°,平均24.7°;跖内翻角无明显变化 ;关节活动幅度33°～60.5°,平均48°。患者对手术满意率100 %,术后优良率92.5 %。结论采用自行研制的硅橡胶假体置换第一跖趾关节 ,手术方法简单 ,骨切除量少 ,效果满意。

Objective To evaluate the effectiveness of first metatarsophalangeal joint arthroplasties in rheumatoid patients with double stemmed flexible hinge silicone prosthesis. Methods From 1993 to 1995, double stemmed flexible hinge silicone prostheses were used to reconstruct elevenmetatarsophalangeal joints in six patients(5 bilateral cases). There were 5 females and 1 male. The age ranged from 27 to 62 years (average 45.25 years). The preoperative average angles of hallux valgus and intermetatarsal angle between first and second metatarsal were 45.6°and 16°respectively. The follow up ranged from 38-59 months(average 49.75 months). The clinical evaluation included the patient's pain relief, shoe wear, toe alignment, range of motion and radiologic study. Results The pain was completely relieved, and the rate of subjective satisfaction is 100%. The average angle of hallux valgus were 24.7°, and the average intermetatarsal angle between first and second metatarsal was not changed, the excellent and good rate was 92.5%. Conclusion The results indicate that this procedure is suitable for severely painful and deformed rheumatoid arthritis of the first metatarsophalangeal joint of rheumatoid and is much more simple and effective than other methods of treatment.