무지 외반증에 동반된 중족 설상 관절염의 방사선학적 특징과 수술적 치료 결과
Radiographic Characteristics and the Clinical Results of the Operative Treatment of the Tarsometatarsal Osteoarthritis with Hallux Valgus Deformity
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To evaluate the radiographic characteristics of the tarsometatarsal osteoarthritis with hallux valgus deformity and report the clinical results of the operative treatment. Materials and Methods: This is a retrospective study of 20 patients, 22 feet who had been operated for non-traumatic tarsometatarsal osteoarthritis with hallux valgus (TMT group) and control group of hallux valgus patients without tarsometatarsal osteoarthritis (26 patients, 28 feet) from April 2004 to July 2011. Radiographic characteristics were compared between the groups, using hallux valgus angle, 1st-2nd intermetatarsal angle, metatarsal length ratio, metatarsus adductus angle, talonavicular coverage angle, talus-1st metatarsal angle, calcaneal pitch angle and medial cuneiform height. Pre- and postoperative difference of 1st-2nd metatarsal declination angle and distance between the 1st-2nd metatarsal head were evaluated. The clinical results were evaluated by American Orthopaedics Foot and Ankle Society (AOFAS) midfoot scale and visual analogue scale (VAS). Results: Metatarsal length ratio was significantly larger in TMT group (p<0.001). Metatarsus adductus angle, talonavicular coverage angle, talus-1st metatarsal angle on lateral radiograph, calcaneal pitch angle and medial cuneiform height were different from control group (p<0.001, p<0.001, p=0.001, p=0.010, p=0.006). Postoperative declination of the 2nd metatarsal and distance between the 1st-2nd metatarsal head were increased (p=0.009, p=0.001). The AOFAS and VAS score were improved (p<0.001, p<0.001). Conclusion: Non-traumatic osteoarthritis of the tarsometatarsal joints seems to be associated with long 2nd metatarsal length,metatarsus adductus and flatfoot deformity. Spur excision may be successful to relieve symptoms when the arthritis was diagnosed in early stage.
Abstract
Purpose: To evaluate the radiographic characteristics of the tarsometatarsal osteoarthritis with hallux valgus deformity and report the clinical results of the operative treatment. Materials and Methods: This is a retrospective study of 20 patients, 22 feet who had been operated for non-traumatic tarsometatarsal osteoarthritis with hallux valgus (TMT group) and control group of hallux valgus patients without tarsometatarsal osteoarthritis (26 patients, 28 feet) from April 2004 to July 2011. Radiographic characteristics were compared between the groups, using hallux valgus angle, 1st-2nd intermetatarsal angle, metatarsal length ratio, metatarsus adductus angle, talonavicular coverage angle, talus-1st metatarsal angle, calcaneal pitch angle and medial cuneiform height. Pre- and postoperative difference of 1st-2nd metatarsal declination angle and distance between the 1st-2nd metatarsal head were evaluated. The clinical results were evaluated by American Orthopaedics Foot and Ankle Society (AOFAS) midfoot scale and visual analogue scale (VAS). Results: Metatarsal length ratio was significantly larger in TMT group (p<0.001). Metatarsus adductus angle, talonavicular coverage angle, talus-1st metatarsal angle on lateral radiograph, calcaneal pitch angle and medial cuneiform height were different from control group (p<0.001, p<0.001, p=0.001, p=0.010, p=0.006). Postoperative declination of the 2nd metatarsal and distance between the 1st-2nd metatarsal head were increased (p=0.009, p=0.001). The AOFAS and VAS score were improved (p<0.001, p<0.001). Conclusion: Non-traumatic osteoarthritis of the tarsometatarsal joints seems to be associated with long 2nd metatarsal length,metatarsus adductus and flatfoot deformity. Spur excision may be successful to relieve symptoms when the arthritis was diagnosed in early stage.
참고문헌 (22)
- Horton GW, "Deformity correction and arthrodesis of the midfoot with a medial plate", Foot Ankle, 14, pp.493~499 (1993)
- Mann RA, "Midtarsal and tarsometatarsal arthrodesis for primary degenerative osteoarthritis or osteoarthritis after trauma", J Bone Joint Surg Am, 78, pp.1376~1385 (1996)
- Jung HG, "Spectrum of operative treatment and clinical outcomes for atraumatic osteoarthritis of the tarsometatarsal joint", Foot Ankle Int, 28, pp.482~489 (2007)
- Ferris LR, "Late reconstruction of the midfoot and tarsometatarsal joints after trauma", Orthop Clin North Am, 26, pp.393~406 (1995)
- Komenda GA, "Results of arthrodesis of the tarsometatarsal joints after traumatic injury", J Bone Joint Surg Am, 78, pp.1665~1676 (1996)
- Snijders CJ, "Biomechanics of hallux valgus and spread foot", Foot Ankle, 7, pp.26~39 (1986)
- Wanivenhaus AH, "Basal osteotomy of the first metatarsal for the correction of metatarsus primus varus associated with hallux valgus", Foot Ankle, 8, pp.337~343 (1988)
- Wanivenhaus AH, "First tarsometatarsal joint : an anatomical and biomechanical study", Foot Ankle, 9, pp.153~154 (1989)
- Ito K, "Degenerative osteoarthrosis of tarsometatarsal joints in hallux valgus : a radiographic study", J Orthop Sci, 8, pp.629~634 (2003)
- Greisberg J, "Deformity and degeneration in the hindfoot and midfoot joints of the adult acquired flatfoot", Foot Ankle Int, 24(7), pp.530~534 (2003)
- Davitt JS, "An association between functional second metatarsal length and midfoot arthrosis", J Bone Joint Surg Am, 87, pp.795~800 (2005)
- Morton DJ, "The human foot; its evolution, physiology and functional disorders", pp.153~186 (1935), Columbia University Press
- Kilmartin TE, "Fusion of the second metatarsocuneiform joint for the painful osteoarthritis", Foot Ankle Int, 29(11), pp.1079~1087 (2008)
- Coughlin MJ, "Juvenile hallux valgus : etiology and treatment", Foot Ankle Int, 16(11), pp.682~697 (1995)
- Chi TD, "The lateral column lengthening and medial column stabilization procedures", Clin Orthop Relat Res, 365, pp.81~90 (1999)
- King DM, "Associated deformities and hypermobility in hallux valgus: an investigation with weightbearing radiographs", Foot Ankle Int, 25(4), pp.251~255 (2004)
- Younger AS, "Radiographic assessment of adult flatfoot", Foot Ankle Int, 26(10), pp.820~825 (2005)
- Thomas JL, "Radiographic values of the adult foot in a standardized population", J Foot Ankle Surg, 45, pp.3~12 (2006)
- Arangio GA, "Radiographic comparison of standing medial cuneiform arch height in adult with and without aquired flatfoot deformity", Foot Ankle Int, 27(8), pp.636~638 (2006)
- Horton GA, "Role of metatarsus primus elevatus in the pathogenesis of hallux rigidus", Foot Ankle Int, 20(12), pp.777~780 (1999)
- Kitaoka HB, "Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes", Foot Ankle Int, 10, pp.193~200 (1994)
- Mann RA, "Biomechanics of the foot and ankle, In Surgery of the Foot and Ankle", pp.29~ (1999), Mosby