Effectiveness analysis of mini external fixator combined with cement spacer in treatment of gouty hallux rigidus with bone defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PAN Peijun , LIN Huijun ,  WANG Lingchun

Department of Orthopedics, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, 200052, P. R. China;

Corresponding author：

WANG Lingchun, Email: wangruoyun1124@hotmail.com

Keywords：

Hallux rigidus; gouty; mini external fixator; bone cement spacer; bone defect

DOI：

10.7507/1002-1892.202506106

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Objective To explore the effectiveness of mini external fixators combined with bone cement spacers in the treatment of gouty hallux rigidus with bone defects. Methods A retrospective analysis was conducted on the clinical data of 21 male patients diagnosed with gouty hallux rigidus and bone defects, treated with mini external fixators combined with bone cement spacers between January 2017 and December 2024. The age ranged from 35 to 72 years, with an average age of 61.1 years. The disease duration was 12-35 years, with an average of 18.2 years. The American College of Rheumatology (ACR) gout score ranged from 16 to 23, with an average of 18.6. All 21 cases of hallux rigidus were classified as grade 3 according to the Coughlin classification. Clinical efficacy was evaluated preoperatively and at 6 months postoperatively using the visual analogue scale (VAS) score for pain, the dorsiflexion angle of first metatarsophalangeal joint in a weight-bearing state, and the American Orthopaedic Foot & Ankle Society (AOFAS) score. Radiological evaluation was performed by measuring the hallux valgus angle (HVA) using weight-bearing X-ray films and the tophi volume using dual-energy CT. Results The operation time ranged from 30 to 56 minutes, with an average of 42.05 minutes. The intraoperative blood loss varied between 10 and 30 mL, averaging 20 mL. All 21 patients were followed up 6-15 months, averaging 9.3 months. One patient experienced delayed wound healing due to the liquefaction of residual tophus; no other patients exhibited complications such as wound or pin tract infections, skin necrosis, fractures, or metastatic metatarsalgia. Six patients experienced acute gout attacks 4-7 days postoperatively, which were effectively alleviated through symptomatic treatment. At 6 months after operation, patients showed significant improvements in HAV, tophus volume, VAS scores, AOFAS scores, and the dorsiflexion angle of first metatarsophalangeal joint compared to preoperative values, with significant differences (P<0.05). Conclusion Mini external fixation combined with a cement spacer is an effective treatment for gouty hallux rigidus with bone defects.

1.	张同, 谢春梅. 高频超声评估痛风患者痛风石及骨侵蚀与临床病程的关系. 中国医学计算机成像杂志, 2025, 31(3): 407-410.
2.	王礼灿, 温成平, 谢志军. 痛风石的诊疗与研究进展. 现代中西医结合杂志, 2012, 21(13): 1468-1469.
3.	肖艳, 李毓婉, 杨瑞芳, 等. 痛风骨侵蚀的研究进展. 中医药通报, 2025, 24(1): 52-56.
4.	Naot D, Pool B, Chhana A, et al. Factors secreted by monosodium urate crystal-stimulated macrophages promote a proinflammatory state in osteoblasts: a potential indirect mechanism of bone erosion in gout. Arthritis Res Ther, 2022, 24(1): 212. doi: 10.1186/s13075-022-02900-z.
5.	邱元洲, 高彦军, 阮培灿, 等. 结构性植骨融合治疗第一跖趾关节严重痛风性关节炎7例. 中国中医骨伤科杂志, 2025, 33(3): 64-67.
6.	Mermerkaya MU, Alkan E, Ayvaz M. evaluation of metatarsal head resurfacing hemiarthroplasty in the surgical treatment of Hallux rigidus: A retrospective study and mid- to long-term follow-up. Foot Ankle Spec, 2018, 11(1): 22-31.
7.	Rajan R, Mishra A. A systematic review of total arthroplasty and arthrodesis for end-stage hallux rigidus: A biomechanical perspective. Foot (Edinb), 2021, 49: 101838. doi: 10.1016/j.foot.2021.101838.
8.	McClelland JA, Allan JJ, Auhl M, et al. Effects of shoe-stiffening inserts on lower extremity kinematics in individuals with first metatarsophalangeal joint osteoarthritis. Arthritis Care Res (Hoboken), 2022, 74(11): 1849-1856.
9.	王凌椿, 潘培军, 陈杰伟, 等. 骨水泥间隔器重建第一跖趾关节痛风性骨缺损的疗效分析. 足踝外科电子杂志, 2022, 9(1): 54-59.
10.	Zang J, Wei F, Shi L, et al. The principle of limb reconstruction-“one walking, two lines, and three balances”: A retrospective analysis of post-traumatic lower limb deformity correction. Orthop Surg, 2024, 16(9): 2252-2263.
11.	朱登伟. 骨外固定支架技术联合踝关节融合术对踝关节创伤患者术后足踝功能及生活质量的影响. 医学理论与实践, 2020, 33(5): 773-774.
12.	闵星星, 王鹏鹏, 刘佳欢, 等. 第1跖趾关节痛风性关节炎的手术治疗进展. 中医正骨, 2018, 30(1): 47-50.
13.	韩欣欣, 张昀, 刘炜, 等. 双能CT在痛风诊疗中的应用. 中华临床免疫和变态反应杂志, 2017, 11(4): 370-374.
14.	王成林, 杨俊忠, 张俊, 等. Masquelet技术治疗第1跖趾关节痛风性关节炎. 中国骨伤, 2017, 30(8): 763-766.
15.	Zhou C, Xue C, Yang B, et al. Amputation of the first metatarsophalangeal joint due to a giant gouty tophi: A case report. Medicine (Baltimore), 2017, 96(43): e8441. doi: 10.1097/MD.0000000000008441.
16.	张贵春, 郑润泉, 邹林, 等. 抗生素骨水泥联合Ilizarov技术在长骨感染性骨缺损治疗中的应用. 实用骨科杂志, 2019, 25(1): 21-28.
17.	邱少东, 刘云宏, 杨海波, 等. 抗生素骨水泥在大段骨缺损合并感染治疗中的应用. 宁夏医科大学学报, 2009, 31(5): 671-672.
18.	丁国成, 刘欣伟, 刘兵, 等. 膜诱导技术结合被覆抗生素骨水泥髓内钉治疗下肢感染性骨缺损. 中华骨科杂志, 2018, 38(9): 530-535.
19.	Guo J, Wang L, Mao R, et al. Biomechanical evaluation of the first ray in pre-/post-operative hallux valgus: A comparative study. Clin Biomech (Bristol), 2018, 60: 1-8.
20.	Qiu XS, Zheng X, Shi HF, et al. Antibiotic-impregnated cement spacer as definitive management for osteomyelitis. BMC Musculoskelet Disord, 2015, 16: 254. doi: 10.1186/s12891-015-0704-1.
21.	Liu F, Huang RK, Xie M, et al. Use of Masquelet’s technique for treating the first metatarsophalangeal joint in cases of gout combined with a massive bone defect. Foot Ankle Surg, 2018, 24(2): 159-163.
22.	秦博泉, 吴仕舟, 解慧琪, 等. 病灶清除联合Ilizarov技术治疗第一跖趾关节痛风石合并骨缺损. 中国修复重建外科杂志, 2020, 34(2): 168-172.
23.	徐永清, 范新宇, 王腾, 等. 3D打印微孔钛假体与皮瓣联合植入治疗四肢大段感染性骨缺损临床疗效. 中国修复重建外科杂志, 2025, 39(5): 521-528.

1. 张同, 谢春梅. 高频超声评估痛风患者痛风石及骨侵蚀与临床病程的关系. 中国医学计算机成像杂志, 2025, 31(3): 407-410.
2. 王礼灿, 温成平, 谢志军. 痛风石的诊疗与研究进展. 现代中西医结合杂志, 2012, 21(13): 1468-1469.
3. 肖艳, 李毓婉, 杨瑞芳, 等. 痛风骨侵蚀的研究进展. 中医药通报, 2025, 24(1): 52-56.
4. Naot D, Pool B, Chhana A, et al. Factors secreted by monosodium urate crystal-stimulated macrophages promote a proinflammatory state in osteoblasts: a potential indirect mechanism of bone erosion in gout. Arthritis Res Ther, 2022, 24(1): 212. doi: 10.1186/s13075-022-02900-z.
5. 邱元洲, 高彦军, 阮培灿, 等. 结构性植骨融合治疗第一跖趾关节严重痛风性关节炎7例. 中国中医骨伤科杂志, 2025, 33(3): 64-67.
6. Mermerkaya MU, Alkan E, Ayvaz M. evaluation of metatarsal head resurfacing hemiarthroplasty in the surgical treatment of Hallux rigidus: A retrospective study and mid- to long-term follow-up. Foot Ankle Spec, 2018, 11(1): 22-31.
7. Rajan R, Mishra A. A systematic review of total arthroplasty and arthrodesis for end-stage hallux rigidus: A biomechanical perspective. Foot (Edinb), 2021, 49: 101838. doi: 10.1016/j.foot.2021.101838.
8. McClelland JA, Allan JJ, Auhl M, et al. Effects of shoe-stiffening inserts on lower extremity kinematics in individuals with first metatarsophalangeal joint osteoarthritis. Arthritis Care Res (Hoboken), 2022, 74(11): 1849-1856.
9. 王凌椿, 潘培军, 陈杰伟, 等. 骨水泥间隔器重建第一跖趾关节痛风性骨缺损的疗效分析. 足踝外科电子杂志, 2022, 9(1): 54-59.
10. Zang J, Wei F, Shi L, et al. The principle of limb reconstruction-“one walking, two lines, and three balances”: A retrospective analysis of post-traumatic lower limb deformity correction. Orthop Surg, 2024, 16(9): 2252-2263.
11. 朱登伟. 骨外固定支架技术联合踝关节融合术对踝关节创伤患者术后足踝功能及生活质量的影响. 医学理论与实践, 2020, 33(5): 773-774.
12. 闵星星, 王鹏鹏, 刘佳欢, 等. 第1跖趾关节痛风性关节炎的手术治疗进展. 中医正骨, 2018, 30(1): 47-50.
13. 韩欣欣, 张昀, 刘炜, 等. 双能CT在痛风诊疗中的应用. 中华临床免疫和变态反应杂志, 2017, 11(4): 370-374.
14. 王成林, 杨俊忠, 张俊, 等. Masquelet技术治疗第1跖趾关节痛风性关节炎. 中国骨伤, 2017, 30(8): 763-766.
15. Zhou C, Xue C, Yang B, et al. Amputation of the first metatarsophalangeal joint due to a giant gouty tophi: A case report. Medicine (Baltimore), 2017, 96(43): e8441. doi: 10.1097/MD.0000000000008441.
16. 张贵春, 郑润泉, 邹林, 等. 抗生素骨水泥联合Ilizarov技术在长骨感染性骨缺损治疗中的应用. 实用骨科杂志, 2019, 25(1): 21-28.
17. 邱少东, 刘云宏, 杨海波, 等. 抗生素骨水泥在大段骨缺损合并感染治疗中的应用. 宁夏医科大学学报, 2009, 31(5): 671-672.
18. 丁国成, 刘欣伟, 刘兵, 等. 膜诱导技术结合被覆抗生素骨水泥髓内钉治疗下肢感染性骨缺损. 中华骨科杂志, 2018, 38(9): 530-535.
19. Guo J, Wang L, Mao R, et al. Biomechanical evaluation of the first ray in pre-/post-operative hallux valgus: A comparative study. Clin Biomech (Bristol), 2018, 60: 1-8.
20. Qiu XS, Zheng X, Shi HF, et al. Antibiotic-impregnated cement spacer as definitive management for osteomyelitis. BMC Musculoskelet Disord, 2015, 16: 254. doi: 10.1186/s12891-015-0704-1.
21. Liu F, Huang RK, Xie M, et al. Use of Masquelet’s technique for treating the first metatarsophalangeal joint in cases of gout combined with a massive bone defect. Foot Ankle Surg, 2018, 24(2): 159-163.
22. 秦博泉, 吴仕舟, 解慧琪, 等. 病灶清除联合Ilizarov技术治疗第一跖趾关节痛风石合并骨缺损. 中国修复重建外科杂志, 2020, 34(2): 168-172.
23. 徐永清, 范新宇, 王腾, 等. 3D打印微孔钛假体与皮瓣联合植入治疗四肢大段感染性骨缺损临床疗效. 中国修复重建外科杂志, 2025, 39(5): 521-528.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesEffectiveness analysis of mini external fixator combined with cement spacer in treatment of gouty hallux rigidus with bone defect

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