目的 探究跖趾关节融合联合跖趾关节成形术治疗老年类风湿前足畸形的短期疗效比较。方法 选取2019年7月至2022年7月我院收治的92例老年类风湿前足畸形患者作为本研究对象,患者均接受跖趾关节融合跖趾关节成形术治疗。对患者进行一年随访,观察患者术前术后拇外翻角（HVA）、第1—2跖骨间角（IMA）变化情况,记录比较术前术后患者的美国足踝外科协会（AOFAS）评分、足底压力情况、疼痛评分（VAS）、Berg平衡量表（BBS）评分、改良Barthel指数（MBI）评分及患者的生活质量评分。结果 与术前比较,术后患者的HVA、IMA均降低,疼痛、功能、足趾力线及AOFAS总分均升高,足底各部分压力均减小,VAS评分降低,BBS评分和MBI评分均升高,生活质量各维度评分均较术前升高。随访期间,92例患者中出现1例术后第1跖趾关节骨不连,3例切口延迟愈合,未发生伤口感染、足趾坏死、复发、形成跖底胼胝等情况。结论 跖趾关节融合联合跖趾关节成形术对老年类风湿前足畸形患者短期疗效显著,可以降低患者的HVA和IMA,改善患者的疼痛情况,减轻足底压力,提高生活质量,能够有效地改善老年类风湿前足畸形患者的结构和功能障碍。
Abstract
Objective To explore the short-term efficacy of metatarsophalangeal joint fusion combined with metatarsophalangeal arthroplasty for rheumatoid forefoot deformity in the elderly. Methods Ninety-two elderly patients with rheumatoid forefoot deformity admitted to our hospital from July 2019 to July 2022 were selected as the subjects of this study, and all of them were treated with metatarsophalangeal joint fusion. The patients were followed up for two months to observe the changes of the hallux valgus Angle (HVA) and the 1st to 2nd intermetatarsal Angle (IMA) before and after surgery. American Society for Foot and Ankle Surgery (AOFAS) score, plantar pressure, pain scale (VAS), Berg Balance Scale (BBS) score, Modified Barthel Index (MBI) score and quality of life score of patients were recorded before and after surgery. Results Compared with preoperative results, postoperative HVA and IMA were decreased, pain, function, toe line of force and total score of AOFAS were increased, pressure in all parts of plantar was decreased, VAS score was decreased, BBS score and MBI score were increased. The scores of all dimensions of quality of life were higher than those before operation . During the follow-up period, among the 92 patients, there was 1 case of bone nonunion of the first metatarsophalangeal joint after surgery, 3 cases of delayed incision healing, and no wound infection, toe necrosis, recurrence, or plantar callose formation. Conclusion Metatarsophalangeal joint fusion combined with metatarsophalangeal arthroplasty has a significant short-term effect in elderly patients with rheumatoid forefoot deformity, which can reduce HVA and IMA, improve pain, reduce plantar pressure, improve quality of life, and effectively improve the structure and dysfunction of elderly patients with rheumatoid forefoot deformity.
关键词
跖趾关节融合术 /
跖趾关节成形术 /
老年类风湿 /
前足畸形
Key words
metatarsophalangeal joint fusion /
metatarsophalangeal arthroplasty /
elderly rheumatoid disease /
forefoot deformity
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基金
江苏省卫生健康委科研项目“LOX-1 介导胰岛素抵抗与老年骨折患者认知功能障碍的关系及机制研究”（H2019057）
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