Orthopedic Foot & Ankle Center, 300 Polaris Parkway, Suite 2000, Westerville, OH 43082, USA.
Foot Ankle Int. 2011 Feb;32(2):158-62. doi: 10.3113/FAI.2011.0158.
Presently, indications for the Lapidus procedure include patients with many pathologies of the first metatarsocuneiform joint. Currently the standard in many areas is that of two or three crossed screws through the first tarsometatarsal region. This type of fixation requires an extended period of nonweightbearing and may be difficult for patient compliance.
The present study is a retrospective comparison of crossed screw fixation to locking plate fixation without a lag screw on union rates, time to weightbearing, and complications.
One hundred forty-three first TMT fusions met the inclusion criteria. There were 96 fused by crossed screw construct (CS) and 47 by the locked plate with or without compression screw (LP). There was a significant difference in time to full weightbearing and union rate. Time to full weightbearing was 8.8 (range, 3 to 16) weeks and 7.8 (range, 1.5 to 34) weeks in the CS and LP groups, respectively (p < 0.001). Union rate was 89.4% (88 of 96 joints) and 98.5% (46 of 47 joints) in the CS and LP groups, respectively (p < 0.001).
We found that when using a dorsal-medial locked plate with or without lag screw lead to a superior rate of union compared to standard crossed screw constructs even while allowing earlier return to full weightbearing.
目前，Lapidus 手术的适应证包括第一跖楔关节多种病变的患者。目前，许多地区的标准是在第一跖跗关节区域通过两到三个交叉螺钉固定。这种固定方式需要长时间不负重，可能难以让患者依从。
本研究是对交叉螺钉固定与无拉力螺钉的锁定钢板固定的融合率、负重时间和并发症的回顾性比较。
143 例第一 TMT 融合符合纳入标准。其中 96 例采用交叉螺钉固定（CS），47 例采用锁定钢板固定（LP）。两组在完全负重时间和融合率方面有显著差异。CS 组的完全负重时间为 8.8 周（范围为 3 至 16 周），LP 组为 7.8 周（范围为 1.5 至 34 周）（p<0.001）。CS 组融合率为 89.4%（88 例），LP 组为 98.5%（46 例）（p<0.001）。
我们发现，与标准交叉螺钉固定相比，使用背侧内侧锁定钢板固定（无论是否使用拉力螺钉）可提高融合率，同时允许更早地完全负重。
