拇僵硬的手术治疗策略

概念

Characterized by first metatarsophalangeal joint (MTP) degeneration and joint pain.

临床表现

Joint degeneration, formation of dorsal osteophytes, pain, limited range of motion.

查体

The pain should be classified as dorsal, medial, and/or sesamoidal.
Passive and active range of motion is decreased most notably in dorsiflexion.
Sensation deficits should be recorded preoperatively (dorsomedial cutaneous nerve)

影像学表现

Decreased joint space 关节间隙变窄
Joint sclerosis 关节硬化
Subchondral cysts 软骨下骨囊肿
Exostoses 外生骨疣
a loose body 关节内游离体

分型

Coughlin and Shurnas developed a useful clinical and radiographical classification, which helps guide treatment of patients suffering from hallux rigidus.

拇僵硬的分型.jpg

治疗

1. Non-surgical treatment includes:
   Foot orthoses (足矫正器) with a firm support under the great toe (Morton’s extension), shoe wear modification, activity modification, medical therapy, and injection therapy.
   For those patients who have failed nonoperative methods, there are many surgical options available.

2. surgical treatment
   Treatment for hallux rigidus has been classified as joint sparing versus joint sacrificing.
   Joint sparing techniques include: cheilectomy, proximal phalangeal osteotomy, first metatarsal osteotomy and interpositional arthroplasty.
   Joint sacrificing techniques include implant arthroplasty and arthrodesis.