慢性関節リウマチの前足部変形に対するLelievre手術の成績

抄録

The forefoot deformities of hallux valgus, claw toes and splayfoot are often encountered in patients who have had rheumatoid arthritis for a long time, and they give the patients great discomfort. Lelievre's procedure, one of the resection arthroplasties, is a useful operative method to correct these deformities and to obtain better function.
Twenty-two operations were performed in 16 patients using the Lelievre's procedure. Among them, 18 feet of 13 patients were available for follow-up; the average age of the patients was 52 years and the average follow-up period was 4 years and 8 months. All of them were women classified as classical RA.
The overall clinical results, as judged by relief of pain, walking ability, improvement of hallux valgus and claw toe deformities, plantar callosities, selection of shoes and the patients' own assessment, were satisfactory (good or excellent) in all feet.
The X - rays at the time of follow -up showed that the hallux valgus angle was significantly improved in all feet. The first and second (fifth) intermetatarsal angles showed no significant difference postoperatively.
The measurement of the relative metatarsal protrusion (Hardy, 1951), defined as the difference between the length of the first and second metatarsals, showed the importance of adequate resection of the metatarsal heads. When the first metatarsal was left longer than the second after surgery, a recurrence of hallux valgus deformity tended to occur. Our experience suggests that a space of 1.5 cm between the resected metatarsal and the proximal phalanx is necessary to prevent new callosity formation and claw toe deformity.