En-block切除术联合结构性植骨治疗第1跖趾关节痛风性关节炎

Treatment of first metatarsophalangeal jointTreatment joint gouty arthritis by arthrodesis withgouty with En-block resection and structural bone graftEn-block graft

背景：痛风性关节炎最常累及第1跖趾关节关节，伴有肿痛、畸形及关节僵硬，严重影响患者的生活质量。目的：探讨采用En-block切除术结合结构性植骨关节融合治疗第1跖趾关节痛风性关节炎的手术技术及疗效。方法：2012年6月至2013年6月，我院共收治8例第1跖趾关节痛风性关节炎患者。男7例，女1例，年龄25~68岁，平均47.6岁。所有患者均采用En-block病灶切除结合结构性植骨第1跖趾关节融合术。术后定期复查，摄片明确愈合情况，并采用美国骨科足踝外科协会（AOFAS）前足评分及疼痛直观模拟量表（VAS）评价治疗效果，记录相关并发症。结果：所有患者伤口均一期愈合，未见伤口感染、皮肤坏死等软组织并发症。术后7例患者获得12~24个月随访，平均18个月。影像学检查明确术后平均10周融合端骨性愈合。AOFAS评分从术前平均（44.4±10.5）分提高至术后（80.0±10.8）分，而VAS评分从术前平均（7.0±2.0）分降至术后（1.1±0.9）分，其差异均有统计学意义（P＜0.0001）。随访期间未见骨不连、畸形愈合及固定失效等并发症。结论：En-block切除结合结构性植骨融合治疗第1跖趾关节痛风性关节炎具有症状缓解明显、融合率高、并发症少等优势，可有效改善患者生活质量，是一种安全有效的治疗方式。

Background：Gouty arthritis most commonly involves the first metatarsophalangeal joint （MTPJ）, causing pain, deformity and anchylosis and reducing patients＇ quality of life. Objective：To investigate the technique and clinical outcome of arthrodesis with En-block resection and structural bone graft to treat the 1st MTPJ gouty arthritis. Methods： From June 2012 to June 2013, 8 patients suffering from 1st MTPJ gouty arthritis were treated in our hospital. There were 7 men and 1 woman with an average age of 47.6 years （range 25-68 years）. The first MTPJ arthrodesis with En-block resection and structural bone graft was performed in all patients. X-rays were taken in regular follow-up to confirm the fusion union. Overall functional evaluation was carried out according to visual analogue scale （VAS） and the forefoot score of American Orthopaedic Foot and Ankle Society （AOFAS） at the last follow-up. Complications were also recorded. Results：All wounds were healed without any soft tissue complications of infection or skin necrosis. Seven patients got the final follow-up of an average 18 months （range, 12-24 months）. X-ray demonstrated the bone union of fusion 10 weeks post-operatively on average. AOFAS score was improved from 44.4 ± 10.5 preoperatively to 80.0 ± 10.8 postoperatively, while VAS score was decreased from 7.0±2.0 to 1.1±0.9. There were significant differences in AOFAS and VAS scores before and after surgery （P〈0.0001）. No complications, such as non-union, malunion or implant failure occurred during follow-up. Conclusions：Arthrodesis with En-block resection and structural bone graft can effectively relieve pain, achieve high fusion rate and low complication rate and improve patients＇ quality of life for the treatment of 1st MTPJ gouty arthritis. It is an effec-tive and safe procedure.