类风湿足2~5跖骨截骨术与跖趾松解术比较

Weil osteotomy versus metatarsophalangeal release of 2~5 toes for rheumatoid forefoot deformities

[目的]比较在第1跖趾融合的基础上,2~5跖骨头Weil截骨与跖趾松解治疗中晚期类风湿足的疗效。[方法]回顾性分析2016年7月—2020年7月手术治疗36例类风湿足患者的临床资料。根据术前医患沟通结果将患者分为两组,在第1跖趾融合的基础上,16例行跖骨头Weil手术(截骨组),20例行跖趾关节松解术(松解组)。比较两组围手术期、随访与影像结果。[结果]两组患者均顺利完成手术,无严重并发症。两组手术时间、切口长度、术中失血量、术中透视次数、切口愈合、住院时间和下地行走时间的差异均无统计学意义(P>0.05),但是截骨组治疗费用显著高于松解组(P<0.05)。两组患者随访(15.23±2.36)个月。随时间推移,两组VAS评分均显著显著减小(P<0.05),而AOFAS、Maryland评分显著增加(P<0.05);截骨组抓地力显著改善(P<0.05),而松解组抓地力无显著变化(P>0.05)。相应时间点,两组VAS、AOFAS、Maryland评分的差异均无统计学意义(P>0.05),但末次随访时,截骨组跖趾关节主动活动抓地力显著优于松解组(P<0.05)。影像方面,两组术后HVA角、IMA角均显著减小(P<0.05),相应时间点,两组HVA角、IMA角的差异均无统计学意义(P>0.05)。[结论]在第1跖趾融合的基础上,2~5跖骨头Weil截骨与跖趾松解均可取得满意临床效果,相比之下,截骨组跖趾抓地力优于松解组。

[Objective] To compare the clinical outcomes of Weil osteotomy versus metatarsophalangeal release of 2~5 toes on the basis of first metatarsophalangeal fusion for rheumatoid forefoot deformities. [Methods] A retrospective study was conducted on 36 patients who underwent surgical treatment for rheumatoid forefoot deformities in our department from July 2016 to July 2020. According to the preoperative doctor-patient communication, the patients were divided into two groups. On the basis of the first metatarsophalangeal fusion, 16 patients received 2~5-toe Weil osteotomy on the metatarsal head(osteotomy group), while the remaining 20 patients received metatarsophalangeal release of 2~5 toes(release group). The documents regarding to perioperative period, follow-up and images were compared between the two groups. [Results] All the patients in both groups had operation performed successfully without serious complications. There were no significant differences between the two groups in terms of operation time, incision length, intraoperative blood loss, intraoperative fluoroscopy times,incision healing, hospital stay, and time to return ambulation(P>0.05), but the treatment cost of osteotomy group was significantly higher than that of release group(P<0.05). As time went in the follow-up lasted for(15.23±2.36) months, the VAS score significantly decreased(P<0.05), while the AOFAS and Maryland scores significantly increased in both groups(P<0.05), additionally, the grip strength in osteotomy group significantly improved(P<0.05), whereas remained unchanged in the release group(P>0.05). At any corresponding time points, there were no significant differences in VAS, AOFAS and Maryland scores between the two groups(P>0.05). However, the osteotomy groups proved significantly superior to the release group in term of grip strength at latest follow-up(P<0.05). Radiographically, both the hallux valgus angle(HVA) and intermetatarsal angle(IMA) significantly decreased postoperatively in the two groups compared with those preoperatively(P<0.05), whereas which proved not statistically significant between the two groups at any corresponding time points(P>0.05). [Conclusion] On the basis of first metatarsophalangeal fusion, both Weil osteotomy and metatarsophalangeal release of the 2~5 toes can achieve satisfactory clinical results for rheumatoid forefoot deformities. In comparison, the osteotomy group has better grip strength than the release group.