骨水泥填充治疗第一跖趾痛风石并骨缺损

Bone cement filling bone defect of the first metatarsal secondary to tophus erosion

摘要:

[目的]评价应用骨水泥填充治疗第一跖趾关节痛风石侵蚀引起的跖骨缺损的疗效。[方法]回顾性分析 2017 年 1 月 —2019 年 12 月本院采用痛风石病灶清除，克氏针骨水泥填充跖骨缺损治疗第一跖趾关节痛风石并骨缺损的患者 32 例，比较术前术后跖趾关节活动度、VAS 评分及母外翻角度。[结果]所有患者均顺利完成手术，术中未出现并发症。所有患者均获随访，随访时间 12~18 个月，平均(15.92±2.41)个月。末次随访时，跖趾关节活动度、VAS 评分、AOFAS母趾跖趾-趾间关节评分均显著改善 (P＜0.05)。X 线片示骨水泥填充牢靠在位，无分离移位，跖趾关节间隙良好。母外翻角较术前无明显变化(P＞0.05)，血清尿酸值术前术后无明显变化(P＞0.05)。[结论]骨水泥填充治疗第一跖趾关节痛风石合并骨缺损，可以最大限度保留跖趾关节功能、改善关节活动度，是治疗中早期第一跖趾关节痛风石的有效术式。

Abstract:

[Objective] To evaluate the clinical outcomes of bone cement filling bone defect of the first metatarsal secondary to tophus erosion. [Methods] A retrospective study was done on 32 patients who received bone cement filling combined with Kirschner wire place- ment for the bone defect of the first metatarsal secondary to tophus debridement in our hospital from January 2017 to December 2019. The metatarsophalangeal range of motion (ROM) , VAS score, hallux valgus angle measured on radiographs and blood uric acid were compared before and after operation. [Results] All patients were successfully operated on without complications, and were followed up for 12~18 months, with a mean of (15.92±2.41) months. At the last follow-up, the ROM, VAS and AOFAS scores significantly improved compared those preoperatively (P＜0.05) . As findings of X-ray films, the bone cement was in place firmly without separation and displacement, while with proper preservation of metatarsophalangeal space and unchanged hallux valgus angle (P＜0.05) . However, the blood uric acid had no significant change before and after operation (P＜0.05) . [Conclusion] Bone cement filling bone defect of the first metatarsal secondary to to- phi removed does preserve the metatarsophalangeal joint function to the maximum extent and improve the range of motion, which is an effec- tive treatment of the first metatarsophalangeal tophi in the early stage.