• 第三軍醫(yī)大學(xué)西南醫(yī)院關(guān)節(jié)外科中心（重慶，400038）;

目的 探討類風(fēng)濕性關(guān)節(jié)炎前足畸形的手術(shù)治療方法及近期療效。 方法 2007 年1 月－ 2009 年8 月，采用第1 跖趾關(guān)節(jié)融合術(shù)聯(lián)合第2 ～ 5 跖趾關(guān)節(jié)成形術(shù)治療7 例類風(fēng)濕性關(guān)節(jié)炎前足畸形女性患者。年齡56 ～ 71 歲，平均62 歲。病程5 ～ 30 年，平均16 年?；颊呔憩F(xiàn)為雙足外翻，第2 ～ 5 趾合并錘狀趾或槌狀趾畸形，其中5 足合并第2 跖趾關(guān)節(jié)半脫位。根據(jù)美國(guó)矯形足踝協(xié)會(huì)（AOFAS）改良標(biāo)準(zhǔn)評(píng)分為（36.9 ± 6.4）分。術(shù)前負(fù)重位X 線片測(cè)量，第1跖趾關(guān)節(jié)外翻角度（46 ± 5）°，第1、2 跖骨間夾角（12 ± 2）°。 結(jié)果 術(shù)后切口均Ⅰ期愈合。術(shù)后3 ～ 4 個(gè)月X 線片復(fù)查示第1 跖趾關(guān)節(jié)達(dá)骨性融合。7 例均獲隨訪，隨訪時(shí)間2 ～ 4 年，平均2.9 年?；颊啧诵胁綉B(tài)均較術(shù)前明顯改善，行走時(shí)足部疼痛明顯緩解。術(shù)后3 個(gè)月X 線片測(cè)量第1 跖趾關(guān)節(jié)外翻角度為（17 ± 4）°，第1、2 跖骨間夾角為（11 ± 2）°，0與術(shù)前比較差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。術(shù)后2 年根據(jù)AOFAS 改良標(biāo)準(zhǔn)評(píng)分為（85.3 ± 5.1）分，與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義（t=4.501，P=0.001）。1 例于術(shù)后4 年前足轉(zhuǎn)移性跖骨痛復(fù)發(fā)，繼續(xù)隨訪中未作特殊處理。 結(jié)論 第1 跖趾關(guān)節(jié)融合術(shù)聯(lián)合第2 ～ 5 跖趾關(guān)節(jié)成形術(shù)治療類風(fēng)濕性關(guān)節(jié)炎前足畸形，可獲得較好外翻矯形，重塑前足負(fù)重面，有效緩解行走時(shí)疼痛。

引用本文： 段小軍,楊柳,戴剛,彭旭. 類風(fēng)濕性關(guān)節(jié)炎前足畸形重建手術(shù)的近期療效. 中國(guó)修復(fù)重建外科雜志, 2012, 26(4): 445-448. doi: 復(fù)制

1. 過邦輔. 類風(fēng)濕性關(guān)節(jié)炎 (十) ——踝關(guān)節(jié)與足類風(fēng)濕性關(guān)節(jié)炎的外科治療. 中華骨科雜志, 1998, 18(10): 637-640.
2. Fishman SA. Rheumatoid arthritis with forefoot reconstruction. J Foot Surg, 1989, 28(3): 204-207.
3. Amin A, Cullen N, Singh D. Rheumatoid forefoot reconstruction. Acta Orthop Belg, 2010, 76(3): 289-297.
4. McKinley JC, Shortt N, Arthur C, et al. Outcomes following pantalar arthrodesis in rheumatoid arthritis. Foot Ankle Int, 2011, 32(7): 681-685.
5. Coughlin MJ, Mann RA. Hallux valgus//Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. 8th ed. St. Louis: Mosby, 2006: 184-354.
6. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum, 1988, 31(3): 315-324.
7. Bolland BJ, Sauvé PS, Taylor GR. Rheumatoid forefoot reconstruction: first metatarsophalangeal joint fusion combined with Weil’s metatarsal osteotomies of the lesser rays. J Foot Ankle Surg, 2008, 47(2): 80-88.
8. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
9. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med, 2011, 365(23): 2205-2219.
10. Doorn PF, Keijsers NL, van Limbeek J, et al. A clinical classification system for rheumatoid forefoot deformity. Foot Ankle Surg, 2011, 17(3): 158-165.
11. van Tuyl LH, Britsemmer K, Wells GA, et al. Remission in early rheumatoid arthritis defined by 28 joint counts: limited consequences of residual disease activity in the forefeet on outcome. Ann Rheum Dis, 2012, 71(1): 33-37.
12. Baan H, Drossaers-Bakker W, Dubbeldam R, et al. We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis. Clin Rheumatol, 2011, 30(11): 1475-1479.
13. Miyamoto W, Takao M, Innami K, et al. Technique tip: interposition of extensor digitorum longus after resection arthroplasty of lesser metatarsophalangeal joints for rheumatoid forefoot deformity. Foot Ankle Int, 2011, 32(2): 211-214.
14. van der Heide HJ, Louwerens JW. Reconstructing the rheumatoid forefoot. Foot Ankle Surg, 2010, 16(3): 117-121.
15. Duan X, Kadakia AR. Salvage of recurrence after failed surgical treatment of hallux valgus. Arch Orthop Trauma Surg, 2012, 132(4): 477-485.
16. Hulse N, Thomas AM. Metatarsal head resection in the rheumatoid foot: 5-year follow-up with and without resection of the first metatarsal head. J Foot Ankle Surg, 2006, 45(2): 107-112.
17. Krause FG, Fehlbaum O, Huebschle LM, et al. Preservation of lesser metatarsophalangeal joints in rheumatoid forefoot reconstruction. Foot Ankle Int, 2011, 32(2): 131-140.
18. 呂厚山, 寇伯龍, 袁燕林, 等. 跖骨頭切除的手術(shù)方法及療效分析24例類風(fēng)濕性關(guān)節(jié)炎前足矯形. 中華骨科雜志, 1996, 16(1): 31-33.
19. Rosenbaum D, Timte B, Schmiegel A, et al. First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot. Foot Ankle Int, 2011, 32(6): 589-594.
  1. 1. 過邦輔. 類風(fēng)濕性關(guān)節(jié)炎 (十) ——踝關(guān)節(jié)與足類風(fēng)濕性關(guān)節(jié)炎的外科治療. 中華骨科雜志, 1998, 18(10): 637-640.
  2. 2. Fishman SA. Rheumatoid arthritis with forefoot reconstruction. J Foot Surg, 1989, 28(3): 204-207.
  3. 3. Amin A, Cullen N, Singh D. Rheumatoid forefoot reconstruction. Acta Orthop Belg, 2010, 76(3): 289-297.
  4. 4. McKinley JC, Shortt N, Arthur C, et al. Outcomes following pantalar arthrodesis in rheumatoid arthritis. Foot Ankle Int, 2011, 32(7): 681-685.
  5. 5. Coughlin MJ, Mann RA. Hallux valgus//Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. 8th ed. St. Louis: Mosby, 2006: 184-354.
  6. 6. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum, 1988, 31(3): 315-324.
  7. 7. Bolland BJ, Sauvé PS, Taylor GR. Rheumatoid forefoot reconstruction: first metatarsophalangeal joint fusion combined with Weil’s metatarsal osteotomies of the lesser rays. J Foot Ankle Surg, 2008, 47(2): 80-88.
  8. 8. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
  9. 9. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med, 2011, 365(23): 2205-2219.
  10. 10. Doorn PF, Keijsers NL, van Limbeek J, et al. A clinical classification system for rheumatoid forefoot deformity. Foot Ankle Surg, 2011, 17(3): 158-165.
  11. 11. van Tuyl LH, Britsemmer K, Wells GA, et al. Remission in early rheumatoid arthritis defined by 28 joint counts: limited consequences of residual disease activity in the forefeet on outcome. Ann Rheum Dis, 2012, 71(1): 33-37.
  12. 12. Baan H, Drossaers-Bakker W, Dubbeldam R, et al. We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis. Clin Rheumatol, 2011, 30(11): 1475-1479.
  13. 13. Miyamoto W, Takao M, Innami K, et al. Technique tip: interposition of extensor digitorum longus after resection arthroplasty of lesser metatarsophalangeal joints for rheumatoid forefoot deformity. Foot Ankle Int, 2011, 32(2): 211-214.
  14. 14. van der Heide HJ, Louwerens JW. Reconstructing the rheumatoid forefoot. Foot Ankle Surg, 2010, 16(3): 117-121.
  15. 15. Duan X, Kadakia AR. Salvage of recurrence after failed surgical treatment of hallux valgus. Arch Orthop Trauma Surg, 2012, 132(4): 477-485.
  16. 16. Hulse N, Thomas AM. Metatarsal head resection in the rheumatoid foot: 5-year follow-up with and without resection of the first metatarsal head. J Foot Ankle Surg, 2006, 45(2): 107-112.
  17. 17. Krause FG, Fehlbaum O, Huebschle LM, et al. Preservation of lesser metatarsophalangeal joints in rheumatoid forefoot reconstruction. Foot Ankle Int, 2011, 32(2): 131-140.
  18. 18. 呂厚山, 寇伯龍, 袁燕林, 等. 跖骨頭切除的手術(shù)方法及療效分析24例類風(fēng)濕性關(guān)節(jié)炎前足矯形. 中華骨科雜志, 1996, 16(1): 31-33.
  19. 19. Rosenbaum D, Timte B, Schmiegel A, et al. First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot. Foot Ankle Int, 2011, 32(6): 589-594.