リウマチ足部手術における当グループの手技・工夫

抄録

 There have been several surgical procedures for metatarsophalangeal (MTP) joint preservation. Every method has been recommended for forefoot deformity in well-controlled rheumatoid arthritis (RA), encouraging surgeons to perform forefoot surgery. In such situations, the modified Scarf osteotomy (horizontal osteotomy＋medial capsular interposition) for hallux valgus (HV), and the modified metatarsal shortening offset osteotomy for lesser toes MTP joint destruction or subluxation have been performed. These procedures have led to good clinical outcomes even in severe cases of deformity or destruction. However, cases of recurrence have also been recognized. Re-subluxation of the MTP joint in lesser toes has been seen in up to 30% of cases, especially in varus hindfoot. Conversely, recurrence of HV deformity has been observed in poorly controlled valgus hindfoot. Taken together, correction of not only the forefoot, but also hindfoot deformity is important. Furthermore, midfoot corrective osteotomy, Ⅴshape osteotomy, rotational osteotomy, and Cotton osteotomy also should be utilized to obtain adequate plantigrade position for cases of varus or inversion. Total ankle arthroplasty is also one of the options for destructive ankle disease. Although subsidence of the talar component needs to be resolved, we have observed good clinical outcomes, with patients having increased social activity in the biological therapy group.