改良斜凯勒囊间置关节置换术与关节融合术治疗晚期第一跖趾关节关节炎15年随访比较。

Foot & Ankle Orthopaedics Pub Date : 2025-03-20 eCollection Date: 2025-01-01 DOI:10.1177/24730114251322766
Jeffrey E Johnson, Andrea R Phinney, Mary K Hastings, Hyo-Jung Jeong, Ling Chen, Andrew P Thome, Jeremy J McCormick, Jonathon D Backus
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引用次数: 0

摘要

背景:虽然跖趾关节(MTPJ)置换术被认为是治疗晚期MTPJ关节炎的“金标准”,改良的斜Keller囊间置关节置换术(MOKCIA)是一种保留MTPJ运动的拇趾僵硬的替代治疗方法。我们的目的是回顾性比较MOKCIA和MTPJ关节融合治疗晚期拇趾僵硬的患者报告的长期结果、x线对准、MTPJ行走运动学和足底压力。方法:从回顾性图表回顾中招募35例患者(MOKCIA [n = 15,平均手术后15年]或关节融合术[n = 20,平均手术后13年])。我们测量了视觉模拟量表(VAS)疼痛和满意度、足踝关节能力测量(FAAM)、患者报告的结果测量信息系统(PROMIS)身体功能评分、x线片、行走MTPJ矢状面运动学、行走时前足和第一趾峰值足底压力、MTPJ角计运动范围和额外手术的需要。组间比较采用双样本t检验或χ2。斯皮尔曼相关被用来检验测量变量之间的关系。结果:组间人口学特征、FAAM活动度日常生活量表(MOKCIA = 94±8,关节融合术= 94±7,P = 0.93)、PROMIS身体功能t评分(MOKCIA = 50±6,关节融合术= 48±6,P = 0.41)、前足、第一趾行走峰值足底压力无差异。MOKCIA患者VAS疼痛虽小但明显降低(MOKCIA = 0.1±0.3,关节融合术= 1.0±1.6,P = 0.02),满意度评分较高(MOKCIA = 9.5±0.9,关节融合术= 8.4±1.8,P = 0.03)。MOKCIA组MTPJ被动偏移弧为44±15度,MOKCIA组第一个MTPJ的角度测量屈曲越大,患者满意度越高(ρ = 0.70, P)。结论:MOKCIA组和关节融合术组的患者均报告了高功能,几乎没有因足趾手术而受到的限制。与关节融合术组相比,MOKCIA组患者的疼痛和满意度相似。这些结果表明,MOKCIA是一种关节范围运动保持替代MTPJ关节固定术长期治疗拇趾僵硬。证据等级:III级,回顾性队列研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Fifteen-Year Follow-up of the Modified Oblique Keller Capsular Interposition Arthroplasty Compared to Arthrodesis for Treatment of Advanced First Metatarsophalangeal Joint Arthritis.

Background: Although metatarsophalangeal joint (MTPJ) arthrodesis is considered the "gold standard" for treatment of advanced MTPJ arthritis, a modified oblique Keller capsular interposition arthroplasty (MOKCIA) is an alternative treatment for hallux rigidus that retains MTPJ motion. We aim to retrospectively compare long-term patient-reported outcomes, radiographic alignment, MTPJ walking kinematics, and plantar pressure between the MOKCIA and MTPJ arthrodesis for advanced hallux rigidus.

Methods: Thirty-five patients were recruited from a retrospective chart review (MOKCIA [n = 15, average 15 years from surgery] or an arthrodesis [n = 20, average 13 years from surgery]). We measured visual analog scale (VAS) pain and satisfaction, Foot and Ankle Ability Measure (FAAM), Patient-Reported Outcomes Measurement Information System (PROMIS) physical function scores, radiographs, walking MTPJ sagittal plane kinematics, forefoot, and first toe peak plantar pressure during walking, MTPJ goniometer range of motion, and need for additional surgery. Two-sample t tests or χ2 were used to compare groups. A Spearman correlation was used to examine the relationships between measured variables.

Results: Groups did not differ on demographic characteristics, FAAM activities of daily living scale (MOKCIA = 94 ± 8, arthrodesis = 94 ± 7, P = .93), PROMIS physical function T-score (MOKCIA = 50 ± 6, arthrodesis = 48 ± 6, P = .41), forefoot, and first-toe walking peak plantar pressure. The MOKCIA had small but significantly lower VAS pain (MOKCIA = 0.1 ± 0.3, arthrodesis = 1.0 ± 1.6, P = .02) and higher satisfaction scores (MOKCIA = 9.5 ± 0.9, arthrodesis = 8.4 ± 1.8, P = .03). MTPJ passive arc of excursion in the MOKCIA group was 44 ± 15 degrees, and greater goniometric measured flexion of the first MTPJ correlated with greater patient satisfaction in the MOKCIA group (ρ = 0.70, P < .01). No MOKCIA patient in our study group required additional surgery.

Conclusion: Patients in both the MOKCIA and arthrodesis groups reported high function with little limitation due to their toe surgery. Patients in the MOKCIA group had similar pain and satisfaction compared with the arthrodesis group. These results suggest MOKCIA is a joint range of motion-preserving alternative to MTPJ arthrodesis for long-term treatment of hallux rigidus.

Level of evidence: Level III, retrospective, cohort study.

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来源期刊
Foot & Ankle Orthopaedics
Foot & Ankle Orthopaedics Medicine-Orthopedics and Sports Medicine
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