リウマチ性前足部障害に対する両足同時Mann変法の短中期成績

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  • 高窪 祐弥
    山形大学医学部代謝再生統御学講座運動機能再建回復学分野
  • 高木 理彰
    山形大学医学部代謝再生統御学講座運動機能再建回復学分野

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  • Mid-term Result of the Modified Mann Procedure for Bilateral Simultaneous Rheumatic Forefoot Deformities
  • リウマチセイ ゼン ソクブ ショウガイ ニ タイスル リョウソク ドウジ Mann ヘンポウ ノ タンチュウキ セイセキ

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Objective: It is well known that the patients with rheumatic diseases, such as rheumatoid arthritis (RA), systemic lupus erythematosus and psoriatic arthritis, often develop small joint destruction symmetry. We report herein on the mid-term result of bilateral simultaneous forefoot arthroplasty with the modified Mann methods in patients with rheumatic diseases. <br>Methods: Ten feet on five patients were operated on. Four patients had RA, and the other had systemic lupus erythematosus. All were women. The mean age at surgery and duration of the affected disease were 54.2 years (5057) and 179 months (115264), respectively. The modified Mann method was applied with a follow-up period of 32 months (range, 1166 months). For lesser toes, metatarsal bone offset osteotomy with preservation of the metatarsophalangeal (MTP) joint was applied for six feet, and resection arthroplasty of MTP joint for four feet. We surveyed radiographic measurements during the follow-up. <br>Results: The mean operation time and duration of hospitalization were 204 (185228) minutes and 29 (2537) days. The patients were able to walk one or two days after surgery with non-weight bearing orthosis of the forefoot. After three weeks, the patients were allowed to walk using full weight bearing with an arch support. Neither disuse of muscle nor bone atrophy was seen in any patient. The Japanese society for Surgery of the Foot RA foot ankle scale was improved to 74 (5896) from 39 (3345) on average. The mean hallux valgus angle improved to 20 (1129) degree from 39 (2751), M1M2 angle to 9 (516) from 14 (1020), and the M1M5 angle to 24 (1931) from 30 (2535), respectively. However, the correction of the hallux valgus angle had decreased at the most recent follow-up compared to that post-surgery. Recurrence of deformity of more than 20 degree of hallux valgus angle formed in three cases at the most recent follow-up, though they had few complain clinically.<br>Conclusion: The bilateral simultaneous forefoot arthroplasty with the modified Mann methods in rheumatoid patients was useful to prevent disuse atrophy and decrease the operative and hospitalization times, because the patients were able to stand and walk very quickly postoperatively with a non-weight bearing orthosis of forefoot after bilateral surgery. It is necessary to improve this method to prevent causing re-deformity, although none of the patients complained about the evident clinical problems.

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