대한족부족관절학회지 (Journal of Korean Foot and Ankle Society)

  • 제16권1호
  • /
  • Pages.47-52
  • /
  • 2012
  • /
  • 1738-3757(pISSN)
  • /
  • 2288-8551(eISSN)
대한족부족관절학회 (Korean Foot & Ankle Society)
권호 표지

류마티스 관절염에 의한 고도의 무지 외반증과 소족지 갈퀴족 변형에 대한 중족골 종축 감압 절골술을 이용한 관절 보존술의 결과

Result of Joint Preserving Surgery Using Axial Shortening Metatarsal Osteotomy for the Treatment of Severe Hallux Valgus and Claw Toes Deformity in Advanced Rheumatoid Arthritis

  • 남일현 (포항성모병원 정형외과) ;
  • 안길영 (포항성모병원 정형외과) ;
  • 문기혁 (포항성모병원 정형외과) ;
  • 이영현 (포항성모병원 정형외과) ;
  • 최성필 (포항성모병원 정형외과) ;
  • 김호규 (포항성모병원 정형외과) ;
  • 오동호 (포항성모병원 류마티스 내과)
  • Nam, Il-Hyun (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Ahn, Gil-Yeong (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Moon, Gi-Hyuk (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Lee, Yeong-Hyeon (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Choi, Seong-Pil (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Kim, Ho-Gyu (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Oh, Dong-Ho (Department of Division of Rheumatology, Pohang St. Mary's Hospital)
  • 투고 : 2012.01.15
  • 심사 : 2012.02.14
  • 발행 : 2012.03.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: The purpose of this study is to evaluate the effect of axial shortening metatarsal osteotomy on the treatment of advanced rheumatoid arthritis patients with severe hallux valgus and claw toe deformity of lesser toes which is used for preserving the metatarsophalangeal joint. Materials and Methods: From January 2005 to June 2009, 18 cases of axial shortening metatarsal osteotomy in advanced rheumatoid arthritis were reviewed ; all of them followed up for more than 2 years after surgical procedures and the mean follow up period was 3.4 years. We performed axial shortening Scarf osteotomy and Akin osteotomy for hallux valgus and Weil osteotomy with soft tissue release for claw toe of lesser toes, respectively. We measured preoperative and postoperative hallux valgus angle, each metatarsal shortening length and the range of motion of the metatarsophalangeal joints through radiographic and clinical examination and compared them each other. Clinical results were evaluated by American Orthopedic Foot and Ankle Society (AOFAS) score and subjective satisfaction of the patients. Results: The hallux valgus angle was reduced from the preoperative mean value of 44.8 degree to 9.0 degree postoperatively and the range of motion of the metatarsophalangeal joint of great toe and lesser toes was increased from the mean of 21.7 degree and 11.0 degree preoperatively to 38.0 degree and 32.5 degree, respectively at postoperation. Also, the mean AOFAS score was improved from 26.5 points to 67.4 points. Conclusion: Axial shortening osteotomy is a useful method to correct the deformity and preserve the metatarsophalangeal joint for severe hallux valgus and claw toe deformity in advanced rheumatoid arthritis.

키워드

참고문헌

  1. Coughlin MJ. Rheumatoid forefoot reconstruction. A long-term follow-up study. J Bone Joint Surg Am. 2000;82:322-41. https://doi.org/10.2106/00004623-200003000-00004
  2. Grondal L, Brostrom E, Wretenberg P, Stark A. Arthrodesis versus Mayo resection: the management of the first metatarsophalangeal joint in reconstruction of the rheumatoid forefoot. J Bone Joint Surg Br. 2006;88:914-9.
  3. Lee KT. Foot and ankle surgery. Seoul: Koonja; 2004. 191-202.
  4. Stevens BW, Anderson JG, Bohay DR. Hallux metatarsophalangeal joint fusion for the rheumatoid forefoot. Foot Ankle Clin. 2007;12:395-404. https://doi.org/10.1016/j.fcl.2007.04.003
  5. Thordarson DB, Aval S, Krieger L. Failure of hallux MP preservation surgery for rheumatoid arthritis. Foot Ankle Int. 2002;23:486-90. https://doi.org/10.1177/107110070202300603
  6. Barouk LS. Forefoot reconstruction. 2nd ed. New York: Springer; 2005. 109-32, 199-210, 299-306.
  7. Barouk LS, Barouk P. Joint-preserving surgery in rheumatoid forefoot: preliminary study with more-than-two-year follow-up. Foot Ankle Clin. 2007;12:435-54. https://doi.org/10.1016/j.fcl.2007.05.006
  8. Berg RP, Kelder W, Olsthoorn PGM, Poll RG. Scarf and Weil osteotomies for correction of rheumatoid forefoot deformities: A review of 20 cases. Foot Ankle Surg. 2007;13:35-40. https://doi.org/10.1016/j.fas.2006.10.001
  9. Fuhrmann RA, Anders JO. The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis. Int Orthop. 2001;25:312-6. https://doi.org/10.1007/s002640100264
  10. Kumar CS, Holt G. Hallux metatarsophalangeal arthroplasty in the rheumatoid forefoot. Foot Ankle Clin. 2007;12:405-16. https://doi.org/10.1016/j.fcl.2007.04.001
  11. Molloy AP, Myerson MS. Surgery of the lesser toes in rheumatoid arthritis: metatarsal head resection. Foot Ankle Clin. 2007;12:417-33. https://doi.org/10.1016/j.fcl.2007.05.001
  12. Amuso SJ, Wissinger HA, Margolis HM, Eisenbeis CH Jr, Stolzer BL. Metatarsal head resection in the treatment of rheumatoid arthritis. Clin Orthop Relat Res. 1971;74:94-100.
  13. Barton NJ. Arthroplasty of the forefoot in rheumatoid arthritis. J Bone Joint Surg Br. 1973;55:126-33.
  14. Faithful DK, Savill DL. Review of the results of excision of the metatarsal heads in patients with rheumatoid arthritis. Ann Rheum Dis. 1971;30:201-2. https://doi.org/10.1136/ard.30.2.201
  15. Newman RJ, Fitton JM. Conservation of metatarsal heads in surgery of rheumatoid arthritis of the forefoot. Acta Orthop Scand. 1983;54:417-21. https://doi.org/10.3109/17453678308996594
  16. Watson MS. A long-term follow-up of forefoot arthroplasty. J Bone Joint Surg Br. 1974;56B:527-33.
  17. Graham CE. Rheumatoid forefoot metatarsal head resection without first metatarsophalangeal arthrodesis. Foot Ankle Int. 1994;15:689-90. https://doi.org/10.1177/107110079401501213
  18. Maestro M, Besse JL, Ragusa M, Berthonnaud E. Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin. 2003;8:695-710. https://doi.org/10.1016/S1083-7515(03)00148-7