Henning Jeffrey A, Jones Clifford B, Sietsema Debra L, Bohay Donald R, Anderson John G
Michigan State University, College of Human Medicine, Department of Orthopaedic Surgery, Orthopaedic Associates of Michigan, Grand Rapids, MI 49503, USA.
Foot Ankle Int. 2009 Oct;30(10):913-22. doi: 10.3113/FAI.2009.0913.
Dislocations and fracture-dislocations involving the tarsometatarsal joint are a relatively common injury. These injuries are associated with long-term disability from subsequent painful osteoarthritis and residual deformity. This study evaluated whether performing a primary arthrodesis (PA) resulted in improved functional outcome and fewer subsequent surgeries as compared to primary open reduction and internal fixation (PORIF).
Forty patients with acute tarsometatarsal joint fractures or fracture dislocations were prospectively randomized to undergo either PORIF or PA. Clinical and radiographic examination, in addition to Short Form-36 (SF-36) and Short Musculoskeletal Function Assessment (SMFA) questionnaires, were evaluated at intervals of 3, 6, 12, and 24 months following surgery in 32 patients. A patient satisfaction phone survey was also performed.
The rate of planned and unplanned secondary surgeries, including hardware removal and salvage arthrodesis, between ORIF and PA groups, 78.6% vs. 16.7% was significantly different. No statistically significant differences were found with physical functioning for the PORIF or PA groups with regard to SF-36 or SMFA scores at any followup time interval. However, time from injury had a significant effect with impaired functioning at three months compared to all future intervals. No difference in satisfaction rates were found between PORIF and PA at an average of 53 months in a phone survey.
PA of tarsometatarsal joint injuries resulted in a significant reduction in the rate of followup surgical procedures if hardware removal is routinely performed with no significant difference in SF-36 and SMFA outcome scores when compared to PORIF.
跗跖关节脱位及骨折脱位是一种相对常见的损伤。这些损伤会导致后续疼痛性骨关节炎和残留畸形，进而造成长期残疾。本研究评估了与一期切开复位内固定术（PORIF）相比，一期关节融合术（PA）是否能改善功能结局并减少后续手术。
40例急性跗跖关节骨折或骨折脱位患者被前瞻性随机分为接受PORIF或PA治疗。除了简明健康调查问卷（SF - 36）和简短肌肉骨骼功能评估（SMFA）问卷外，还对32例患者在术后3、6、12和24个月进行临床和影像学检查。还进行了患者满意度电话调查。
ORIF组和PA组之间计划内和计划外二次手术的发生率，包括取出内固定物和补救性关节融合术，分别为78.6%和16.7%，差异有统计学意义。在任何随访时间间隔，PORIF组或PA组在SF - 36或SMFA评分方面的身体功能方面均未发现有统计学意义的差异。然而，与所有后续时间间隔相比，受伤后3个月时功能受损，受伤时间有显著影响。在平均53个月的电话调查中，PORIF组和PA组的满意度率没有差异。
如果常规取出内固定物，跗跖关节损伤的PA可显著降低随访手术率，与PORIF相比，SF - 36和SMFA结局评分无显著差异。
