Hyer Christopher F, Glover Jason P, Berlet Gregory C, Lee Thomas H
Orthopedic Foot and Ankle Center, 6200 Cleveland Avenue, Ste 100 Columbus, OH 43231, USA.
J Foot Ankle Surg. 2008 Jan-Feb;47(1):13-8. doi: 10.1053/j.jfas.2007.08.016. Epub 2007 Nov 13.
Expensive surgical implants can significantly add to the cost of a procedure. We performed a crude cost analysis to evaluate and compare the crossed screw technique versus dorsal plating for first metatarsophalangeal arthrodesis. First metatarsophalangeal arthrodeses performed over a 20-month period were selected. Exclusion criteria included diabetes, neuroarthropathy, revision surgery, or alternate fixation. Hospital records were reviewed for each case to determine implant charges. Patient charts and radiographs were also reviewed to determine time to fusion, delayed union/nonunion, revision surgery, or hardware removal. Fifty-five first metatarsophalangeal arthrodeses were performed during the study period. Ten fusions were excluded, leaving 45 fusions for review. The overall fusion rate was 91.1%. The average time to fusion in crossed screw versus plating technique was 73.2 +/- 32.5 days (range, 43 to 162) and 69.3 +/- 37.3 days (range, 44 to 238), respectively, and not statistically significant. The mean implant cost in the crossed screw versus dorsal plating technique was $374.05 +/- 76.3 (range, 278.72 to 530.00) and $603.57 +/- 234.7 (range, 543.40 to 1677.00) respectively and was strongly significant (P = .0002). Complications included 2 delayed unions (1 screw, 1 plate), 4 nonunions (1 screw, 3 plate), 2 revisions (1 screw, 1 plate), and 2 hardware removals (1 screw, 1 plate).
A cost comparison of crossed screws versus dorsal plate construct for first metatarsophalangeal arthrodesis is performed. No statistical difference was found in the time to fusion between the 2 constructs but there was strong statistical difference in hardware cost. This information may aid in the cost management of this procedure without compromising clinical results. ACFAS Level of Clinical Evidence: 2c.
昂贵的外科植入物会显著增加手术成本。我们进行了一项粗略的成本分析，以评估和比较交叉螺钉技术与背侧钢板用于第一跖趾关节融合术的情况。选取了在20个月期间进行的第一跖趾关节融合术病例。排除标准包括糖尿病、神经关节病、翻修手术或其他固定方式。查阅每个病例的医院记录以确定植入物费用。还查阅患者病历和X线片以确定融合时间、延迟愈合/不愈合、翻修手术或取出内固定物的情况。在研究期间共进行了55例第一跖趾关节融合术。排除10例融合病例，剩余45例融合病例用于分析。总体融合率为91.1%。交叉螺钉技术与钢板技术的平均融合时间分别为73.2±32.5天（范围43至162天）和69.3±37.3天（范围44至238天），差异无统计学意义。交叉螺钉技术与背侧钢板技术的平均植入物成本分别为374.05±76.3美元（范围278.72至530.00美元）和603.57±234.7美元（范围543.40至1677.00美元），差异有高度统计学意义（P = .0002）。并发症包括2例延迟愈合（1例螺钉，1例钢板）、4例不愈合（1例螺钉，3例钢板）、2例翻修手术（1例螺钉，1例钢板）和2例取出内固定物（1例螺钉，1例钢板）。
对交叉螺钉与背侧钢板用于第一跖趾关节融合术进行了成本比较。两种固定方式在融合时间上无统计学差异，但在硬件成本上有显著统计学差异。该信息可能有助于该手术的成本管理，且不影响临床效果。美国足踝外科协会临床证据水平：2c。
