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

摘要:

［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。

Abstract:

[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 un- derwent 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 re- ceived 2~5- toe Weil osteotomy on the metatarsal head (osteotomy group), while the remaining 20 patients received metatarsophalangeal re- lease 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 signifi- cant 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.