Swanson人工跖趾关节置换术治疗终末期第二跖趾关节病

Treatment of late-stage second metatarsophalangeal joint disease using a double stemmed flexible silicone prosthesis

目的探讨Swanson人工跖趾关节置换术治疗终末期第二跖趾关节病的临床疗效。方法分析2009年1月至2021年9月首都医科大学附属北京同仁医院足踝外科中心及同济大学附属同济医院骨科收治的第二跖趾关节病患者资料,应用Swanson可屈曲铰链式跖趾关节假体实施人工跖趾关节置换第二跖趾关节手术36例(共36趾)。采用美国足踝外科协会Maryland跖趾关节百分评分系统、疼痛视觉模拟评分法(visual analogue scale,VAS)评分和美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分对疼痛、功能及客观体征进行评分。结果36例(36趾)获得随访,随访时间18~86个月,平均38.1个月。Maryland评分术前为43~78分,平均62.5分;术后为67~95分,平均91.8分。优26例(72.2%),良8例(22.2%),可2例(5.6%),手术优良率为94.4%。VAS平均评分从术前8.4(6~9)分改善到术后2.4(1~5)分,差异有统计学意义(P<0.05)。末次随访AOFAS评分为86.5(73~92)分,较术前56.3(42~68)分显著提高(P<0.05)。术后发生伤口延迟愈合2例及伤口感染1例,无假体脱位,无反应性滑膜炎。结论Swanson人工跖趾关节置换术治疗终末期第二跖趾关节病的疗效较好,优良率高,可以保留跖趾关节功能,患者满意度高。

Objective To evaluate the clinical outcomes of double stemmed flexible silicone prosthesis for the treatment of second metatarsophalangeal joint disease in its late stages.Methods Between January 2009 and September 2021,36 patients(36 toes)underwent second metatarsophalangeal joint arthroplasty using the Swanson double stemmed flexible silicone prosthesis at the Foot and Ankle Surgery Center,Capital Medical University Affiliated Beijing Tongren Hospital and Department of Orthopedics,Tongji Hospital of Tongji University.The Maryland metatarsophalangeal joint score,visual analogue scale(VAS)pain score and American Orthopaedic Foot and Ankle Society(AOFAS)foot score were used to evaluate pain,function and objective signs.Results 36 cases involving 36 toes were followed up for a period of 18 to 86 months,with a mean follow-up time of 38.1 months.The Maryland score for these cases ranged from 43 to 78 points,with a mean score of 62.5 points.The mean postoperative Maryland score was 91.8(67~95)points.Of the 36 cases,26(72.2%)showed excellent results,8(22.2%)showed good results,and 2 case(5.6%)showed fair results,the combined excellent and good rate was 94.4%.The average VAS score improved significantly from 8.4(6~9)points preoperatively to 2.4(1~5)points postoperatively(P<0.05).At the last follow-up,the AOFAS score was 86.5(73~92)points,which was significantly higher than the preoperative score of 56.3(42~68)points(P<0.05).Only two cases experienced delayed wound healing and one case developed wound infection,and there were no cases of prosthesis dislocation or reactive synovitis.Conclusion The double stemmed flexible silicone prosthesis is an effective treatment for late-stage second metatarsophalangeal joint disease,resulting in a high rate of excellent and good outcomes.This procedure preserves the function of the metatarsophalangeal joint and is associated with high patient satisfaction.