目的: 探讨使用Swanson双柄硅胶假体行跖趾关节置换治疗骨性关节炎、类风湿关节炎等引起的第2~5跖趾关节病变的中长期临床疗效。方法: 2010年1月至2015年10月应用Swanson双柄硅胶假体实施第2~5跖趾关节置换术21例,成功随访16例,其中,男性2例,女性14例,平均年龄(66.7±5.5)岁,类风湿关节炎9例,严重骨性关节炎5例,跖骨头骨软骨病2例。采用美国足踝外科协会Maryland足部评分系统、视觉模拟评分(visual analogue score, VAS)和影像学检查等方法对手术前后行走及跖趾关节活动度、疼痛程度等进行临床评价。结果: 随访时间17个月至5年,平均3.2年。Maryland足部评分:术前为(60.69±6.12)分,术后末次随访时为(88.13±5.84)分。术前跖趾关节活动度:背伸5.4°±3.1°,跖屈4.4°±2.7°;术后:背伸15.7°±4.5°,跖屈12.2°±4.3°,术后跖趾关节活动度较术前有明显改善,数据对比差异有统计学意义(P<0.01)。VAS评分:术前评分为(6.8±0.9)分,术后末次随访为(2.3±0.8)分,术后跖趾关节疼痛症状得到明显改善。根据美国足踝外科协会Maryland足部评分系统,术后评分较术前评分有显著性提高(P<0.01),优良率达到81.3%。结论: Swanson双柄硅胶假体跖趾关节置换术能够较好地缓解疼痛, 增加关节活动范围及稳定性,维持前足正常的行走能力,是重建第2~5跖趾关节结构、恢复关节功能的有效方法,但仍存在一些不良反应的发生概率,需要进一步改进。

Objective: Metatarsophalangeal joint is an important joint for daily weight-bearing walking. Osteoarthritis, osteochondrosis of the metatarsal head, rheumatoid arthritis can often cause the destruction of 2-5 metatarsophalangeal joint, leading to pain, limited joint movement and toe deformities, severely affecting the forefoot function. The purpose of this study is to report the results of middle-long term follow-up after performing Swanson double-stem silicon implant arthroplasty in patients with diseases of 2-5 metatarsophalangeal joint. Methods: From January 2010 to October 2015, 21 patients with 2-5 metatarsophalangeal joint replacement were performed with Swanson double-stem silicone prosthesis. In the study, 16 cases were successfully followed up,2 men and 14 women with an average age (66.7±5.5) years. There were 9 cases diagnosed with rheumatoid arthritis, 5 cases with severe osteoarthritis and 2 cases with osteochondrosis of the metatarsal head. The American Association of foot and ankle surgery Maryland foot scoring system and visual analogue score (VAS) were used to evaluate the walking function, metatarsophalangeal joint mobility and pain degree before and after surgery. Results: The follow-up time ranged from 17 months to 5 years, with an average of 3.2 years. According to Maryland foot scoring system of the American Association of foot and ankle surgery, the preoperative score was (60.69±6.12) points and postoperative score was (88.13±5.84) points. Range of motion of metatarsophalangeal joint: preoperative: back extension 5.4°±3.1°, plantar flexion 4.4°±2.7°; postoperative: back extension 15.7°±4.5°, plantar flexion 12.2°±4.3°, the motion of 2-5 metatarsophalangeal joint after operation was significantly improved compared with that before operation (P<0.01). The preoperative VAS was (6.8±0.9) points and the last follow-up was (2.3±0.8) points, the pain symptom of metatarsophalangeal joint was improved obviously after operation. The postoperative score was significantly higher than the preoperative score according to Maryland foot scoring system (P<0.01), the excellent rate was 81.3%. Conclusion: With the advantages of alleviating pain, preserving the length and alignment of metatarsophalangeal joint, improving the function of walking, and correcting the deformity, Swanson double-stem silicon implant arthroplasty is a reproducible and safe option for the reconstruction of the 2-5 metatarsophalangeal joint. However, there is still some probability of adverse reactions and still room for improvement.