第一跖趾關節成形術與第一跖趾關節融合術比較治療類風濕前足畸形的Meta分析_《中國循證醫學雜志》

作者：

 陳剛 ¹ , 李兵兵 ¹ , 陳封明 ¹ , 任鵬 ¹ , 劉玉 ²

1. 新疆醫科大學第一附屬醫院顯微修復外科（烏魯木齊 830054）；2. 新疆醫科大學第一附屬醫院循證醫學教研室（烏魯木齊 830054）;

關鍵詞：

第一跖趾關節切除成形術第一跖趾關節融合術類風濕前足畸形系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130040

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目的　系統評價第一跖趾關節切除成形術與第一跖趾關節融合術比較治療類風濕前足畸形的臨床療效。
方法　計算機檢索CNKI、Ovid、MEDLINE、CBM、EMbase、WanFang Data、The Cochrane Library（2012年第1期）以及康健循證醫學知識倉庫，查找第一跖趾關節切除成形術與第一跖趾關節融合術比較治療類風濕前足畸形的隨機對照試驗（RCT），檢索時間截至2012年2月。由2位研究者按照納入和排除標準獨立篩選文獻、提取資料和評價質量后，采用RevMan5.1軟件進行Meta分析。
結果　最終納入4個RCT，共計206例患者（269只足），其中第一跖趾關節切除成形術組98例（130只足），第一跖趾關節融合術組108例（139只足）。Meta分析結果顯示：第一跖趾關節融合術在穿鞋、外觀的評分方面優于第一跖趾關節切除成形術，其差異均有統計學意義［穿鞋：MD=?0.88，95%CI（?1.55，?0.22），P=0.01；外觀：MD=?5.04，95%CI（?8.94，?1.14），P lt;0.000 01］；但兩者在患者滿意度、轉移性病損、疼痛、日常及體育活動和拇趾區承重壓力的評分方面，其差異均無統計學意義。
結論　第一跖趾關節融合術治療類風濕前足畸形療效優于第一跖趾關節切除成形術。受納入研究質量的限制和可能存在發表偏倚的影響，上述結論尚需開展更多高質量的隨機雙盲對照試驗加以驗證。

引用本文： 陳剛,李兵兵,陳封明,任鵬,劉玉. 第一跖趾關節成形術與第一跖趾關節融合術比較治療類風濕前足畸形的Meta分析. 中國循證醫學雜志, 2013, 13(2): 236-241. doi: 10.7507/1672-2531.20130040 復制

1.	Lui TH. Technical tips: Modified resection arthroplasty for correction of rheumatoid forefoot deformity. Foot Ankle Surg, 2010, 16(2): 74-77.
2.	Grondal L, Brostrom E, Wretenberg P, et al. Arthrodesis versus Mayo resection:the management of the first metatarsophalangeal joint in reconstruction of the roeumatoid forefoot. J Bone Joint Surg Br, 2006, 88(7): 914-919.
3.	Amin A, Cullen N, Singh D. rheumatoid forefoot reconstruction. Acta Orthop Belg, 2010, 76(3): 289-297.
4.	Hamalainen M, Raunio P. Long-term follow up of rheumatoid forefoot surgery. Clin Orthop Relat Res, 1997, 340: 34-38.
5.	Mann RA, Schakel ME 2nd. Surgical correction of rheumatoid forefoot deformities. Foot Ankle Int, 1995, 16(1): 1-6.
6.	Mulcahy D, Daniels TR, Lau JT, et al. Rheumatoid forefoot deformities: a comparison study of 2 functional methods of reconstruction. J Rheumatol, 2003, 30(7): 1440-1450.
7.	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.
8.	Torikai E, Kageyama Y, Suzuki M, et al. Comparison between resection arthroplasty alone and resection arthroplasty with arthrodesis of the first MTP joint for rheumatoid forefoot deformities. Mod Rheumatol, 2008, 18(5): 486-491.
9.	Vandeputte G, Steenwerckx A, Mulier T, et al. Forefoot reconstruction in rheumatoid arthritis patients:Keller-Lelievre-Hoffmann versus arthrodesis MTP1-Hoffmann. Foot Ankle Int, 1999, 20(7): 438-443.
10.	Coughlin MJ. Rheumatoid forefoot reconstruction. A long-term follow-up study. J Bone Joint Surg Am, 2000, 82(3): 322-341.
11.	Kitaoka HB, Alexander LJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
12.	Jadad AR, Moore RA, Corral D. Assessing the quality of the reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
13.	Popelka S, Hromadka R, Bartak V. Bilateral arthrodesis of the medial foot joints in a patient with rheumatoid arthritis. Acta Chir Orthop Traumatol Cech, 2012, 79(1): 74-79.
14.	Turner DE, Helliwell PS, Emery P. The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series. BMC Musculoskelet Disord, 2006, 7N: 102.
15.	Suckel A, Wulker N. Arthrodesis of the first metatarsophalangeal joint. Orthopade, 2006, 35(4): 443-449.
16.	Lombardi CM, Silhanek AD, Connolly FG, et al. The effect of first metatarsophalangeal joint arthrodesis on the first ray and the medial longitudinal arch:a radiographic study. J Foot Ankle Surg, 2002, 41(2): 96-103.
17.	Hoffman P. An operation for severe grades of contracted or clawed toes. Am J Orthop Surg, 1912, s2-9(3): 441.
18.	Burra G, Katchis SD. Rhenmatoid arthritis of the forefoot. Rheum Dis Clin North Am, 1998, 24(1): 173-180.
19.	Bolland BJ, Sauve 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.
20.	Fuhrmann RA. The treatment of rheumatoid foot deformities. Orthopade, 2002, 31(12): 1187-1197.
21.	Reize P, Leichtle CI, Leichtle UG. Long-term results after metatarsal head resection in the treatment of rheumatoid arthritis. Foot Ankle Int, 2006, 27(8): 586-590.
22.	Fuhrmann RA, Anders JO. The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis. Int Orthop, 2001, 25(5): 312-316.
23.	Hattori H, Mibe J, Nohara A, et al. Course of damage to the hallux over 5 years after forefoot resection arthroplasty in rheumatoid arthritis patients. Int Orthop, 2007, 31(4): 477-481.

1. Lui TH. Technical tips: Modified resection arthroplasty for correction of rheumatoid forefoot deformity. Foot Ankle Surg, 2010, 16(2): 74-77.
2. Grondal L, Brostrom E, Wretenberg P, et al. Arthrodesis versus Mayo resection:the management of the first metatarsophalangeal joint in reconstruction of the roeumatoid forefoot. J Bone Joint Surg Br, 2006, 88(7): 914-919.
3. Amin A, Cullen N, Singh D. rheumatoid forefoot reconstruction. Acta Orthop Belg, 2010, 76(3): 289-297.
4. Hamalainen M, Raunio P. Long-term follow up of rheumatoid forefoot surgery. Clin Orthop Relat Res, 1997, 340: 34-38.
5. Mann RA, Schakel ME 2nd. Surgical correction of rheumatoid forefoot deformities. Foot Ankle Int, 1995, 16(1): 1-6.
6. Mulcahy D, Daniels TR, Lau JT, et al. Rheumatoid forefoot deformities: a comparison study of 2 functional methods of reconstruction. J Rheumatol, 2003, 30(7): 1440-1450.
7. 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.
8. Torikai E, Kageyama Y, Suzuki M, et al. Comparison between resection arthroplasty alone and resection arthroplasty with arthrodesis of the first MTP joint for rheumatoid forefoot deformities. Mod Rheumatol, 2008, 18(5): 486-491.
9. Vandeputte G, Steenwerckx A, Mulier T, et al. Forefoot reconstruction in rheumatoid arthritis patients:Keller-Lelievre-Hoffmann versus arthrodesis MTP1-Hoffmann. Foot Ankle Int, 1999, 20(7): 438-443.
10. Coughlin MJ. Rheumatoid forefoot reconstruction. A long-term follow-up study. J Bone Joint Surg Am, 2000, 82(3): 322-341.
11. Kitaoka HB, Alexander LJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
12. Jadad AR, Moore RA, Corral D. Assessing the quality of the reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
13. Popelka S, Hromadka R, Bartak V. Bilateral arthrodesis of the medial foot joints in a patient with rheumatoid arthritis. Acta Chir Orthop Traumatol Cech, 2012, 79(1): 74-79.
14. Turner DE, Helliwell PS, Emery P. The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series. BMC Musculoskelet Disord, 2006, 7N: 102.
15. Suckel A, Wulker N. Arthrodesis of the first metatarsophalangeal joint. Orthopade, 2006, 35(4): 443-449.
16. Lombardi CM, Silhanek AD, Connolly FG, et al. The effect of first metatarsophalangeal joint arthrodesis on the first ray and the medial longitudinal arch:a radiographic study. J Foot Ankle Surg, 2002, 41(2): 96-103.
17. Hoffman P. An operation for severe grades of contracted or clawed toes. Am J Orthop Surg, 1912, s2-9(3): 441.
18. Burra G, Katchis SD. Rhenmatoid arthritis of the forefoot. Rheum Dis Clin North Am, 1998, 24(1): 173-180.
19. Bolland BJ, Sauve 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.
20. Fuhrmann RA. The treatment of rheumatoid foot deformities. Orthopade, 2002, 31(12): 1187-1197.
21. Reize P, Leichtle CI, Leichtle UG. Long-term results after metatarsal head resection in the treatment of rheumatoid arthritis. Foot Ankle Int, 2006, 27(8): 586-590.
22. Fuhrmann RA, Anders JO. The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis. Int Orthop, 2001, 25(5): 312-316.
23. Hattori H, Mibe J, Nohara A, et al. Course of damage to the hallux over 5 years after forefoot resection arthroplasty in rheumatoid arthritis patients. Int Orthop, 2007, 31(4): 477-481.

《中國循證醫學雜志》

第一跖趾關節成形術與第一跖趾關節融合術比較治療類風濕前足畸形的Meta分析

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《中國循證醫學雜志》

第一跖趾關節成形術與第一跖趾關節融合術比較治療類風濕前足畸形的Meta分析

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