文献简介

出版社:Clin Rheumatol

作  者:Siddle HJ, Redmond AC, Waxman R, Dagg AR, Alcacer-Pitarch B, Wilkins RA, Helliwell PS

编  号:10.1007/s10067-012-2134-x. Epub 2012 Dec 18

关键字:Callusdebridement.Forefootpain.Metatarsophalangealjoint.Plantarcallosities.Rheumatoid arthritis

年  份:2012   点击量:906

文献摘要

       The objective of this study was to evaluate the long-term benefits of sharp scalpel debridement of painful forefoot plantar callosities in rheumatoid arthritis (RA). The null hypothesis: sharp scalpel debridement would offer no additional long-term advantage in terms of pain and function. Sixty-five people with RA were randomised to receive regular sharp scalpel debridement of painful forefoot plantar callosities in conjunction with a combined therapeutic approach or a combined therapeutic approach alone. The primary outcome measure was change at 18 months in participant-reported forefoot plantar pain measured by a 100-mm visual analogue scale (VAS). Secondary outcome measures were recorded at baseline and study exit and included revised Foot Function Index, Health Assessment Questionnaire, Foot Impact Scale and gait parameters. At 18 months, there were no differences between groups for the primary outcome VAS-measured forefoot plantar pain (left foot (F = 0.23, p = 0.635), right foot (F = 2.14, p = 0.148)). Within-group changes were highly significant (treatment arm, difference = 16.9 (95 % confidence interval (CI) 9.4, 24.4), t = 4.6, p < 0.0001; control arm, difference = 17.5 (95 % CI 9.4, 25.5), t = 4.4, p < 0.0001). There was little change in scores of overall function and foot impact in either group and there were no significant changes in gait parameters noted. The long-term effects of sharp scalpel debridement of painful forefoot plantar callosities in people with RA, when used in conjunction with a combined therapeutic approach, produced no additional benefit over the combined therapeutic approach alone.
 

    本研究旨在评估对类风湿关节炎(RA)患者疼痛的前掌足底胼胝进行外科手术清创的长远益处。零假设:就其所产生的痛苦和作用而言,外科手术清创没有提供额外的长期益处。从65名类风湿关节炎伴有令人不适的前脚掌足底胼胝的患者中随机选取一部分定期接受外科手术清创同时使用联合治疗,剩下的仅接受联合治疗。关于参与者前脚跖疼痛(通过一个100毫米的视觉模拟评分法测定)的主要结果测定在18个月内发生变化。次要结果测定在研究初始和结束后进行记录,包括修订的足部功能指数,健康评估问卷,足部冲击量表和步态参数。在18个月左右,两组之间的VAS测测定前脚跖疼痛(左脚(F=0.23P= 0.635),右脚(F =2.14P= 0.148)的结果无显著差异。组内变化非常显著(治疗组,差异=16.995%可信区间(CI9.424.4),T= 4.6P <0.0001;对照组,差异=17.595CI9.4%,25.5T =4.4P <0.0001)。两组在整体功能和足部治疗效果上的分数变化不大,且步态参数并没有显着变化。外科手术清创与联合治疗方法相结合治疗类风湿关节炎患者的前脚跖部胼胝,其长期效果与仅用联合方法治疗相比没有优势。