University of Tennessee College of Medicine, Chattanooga, TN, USA.
Foot Ankle Int. 2013 Nov;34(11):1535-40. doi: 10.1177/1071100713494779. Epub 2013 Jun 26.
Many techniques have been described for arthrodesis of the first metatarsophalangeal (MTP) joint. The purpose of this study was to determine the results of fixation using a low-profile dorsal titanium plate with locking screws in the phalanx, nonlocking screws in the metatarsal, and a plantar neutralization screw.
Forty-nine consecutive patients (51 feet) underwent a first MTP joint arthrodesis during an enrollment period of 1 year from October 2010 to November, 2011. All patients were evaluated preoperatively for primary pathology, pain, function, radiographic findings, AOFAS scores, and physical exam findings. First MTP joint arthrodesis was performed with a precontoured dorsal titanium plate with preset valgus and dorsiflexion after the joint surfaces were prepared with dome-shaped power reamers to achieve congruous cancellous bone surfaces. At a minimum of 1-year follow-up, patients returned for postoperative evaluation of pain, function, radiographic findings, satisfaction, AOFAS scores, and physical exam findings.
Forty-six of 49 (48 feet) patients returned for final follow-up examination at least 12 months after operative intervention. Forty-one patients (89%) reported good to excellent results. Visual analog pain scores improved from an average of 6.6 preoperatively to an average of 1.6 postoperatively (t = -9.3339, df = 45, P < .001). Functional capacity scores improved from a preoperative mean of 2.5 to a postoperative mean of 1.4 (t = -5.2648, df = 46, P < .001). AOFAS hallux MTP joint scores improved from a preoperative mean of 45 to a postoperative mean of 77 (t = 9.9498, df = 46, P < .003). Eighteen of 48 great toes (38%) had preoperative pronation whereas, 2 of 48 great toes (4%) had postoperative pronation. Eleven of 46 patients (24%) were unable to perform preoperative toe rise, and 8 of 46 (17%) were unable to perform postoperative toe rise. Twenty-five of 46 patients (54%) had gait improvement, while 19 patients (44%) had no change in gait, and 2 patients (4%) had gait deterioration. The mean preoperative hallux valgus angle of 27 degrees improved to a mean postoperative angle of 13 degrees (t = -6.1982, df = 46, P < .001). The mean preoperative 1-2 intermetatarsal angle of 12 degrees improved to a mean postoperative angle of 9 degrees (t = -5.2614, df = 46, P < .001). There was 1 delayed union (2%) and 1 nonunion (2%).
Our outcome scores indicate that first MTP joint arthrodesis with a precontoured dorsal titanium plate with locking screws in the phalanx and nonlocking screws in the first metatarsal is both reliable and reproducible with a very high bony union rate.
Level IV, prospective case series.
许多技术已经被描述用于第一跖趾关节（MTP）关节融合术。本研究的目的是确定使用背侧钛板的固定效果，该钛板在趾骨上使用锁定螺钉，在跖骨上使用非锁定螺钉，以及使用跖骨中和螺钉。
在 2010 年 10 月至 2011 年 11 月的 1 年入组期间，连续有 49 例患者（51 足）接受了第一 MTP 关节融合术。所有患者均在术前进行了主要病理、疼痛、功能、影像学检查、AOFAS 评分和体格检查结果的评估。在准备好关节表面后，使用球形动力扩孔器进行准备，以实现一致的松质骨表面，然后使用预弯的背侧钛板进行第一 MTP 关节融合术。在至少 1 年的随访中，患者返回进行术后疼痛、功能、影像学检查、满意度、AOFAS 评分和体格检查结果的评估。
在手术干预后至少 12 个月，49 例患者中的 46 例（48 足）返回进行了最终随访检查。41 例患者（89%）报告结果良好或优秀。视觉模拟疼痛评分从术前平均 6.6 分改善至术后平均 1.6 分（t = -9.3339，df = 45，P <.001）。功能能力评分从术前平均 2.5 分改善至术后平均 1.4 分（t = -5.2648，df = 46，P <.001）。AOFAS 踇趾 MTP 关节评分从术前平均 45 分提高至术后平均 77 分（t = 9.9498，df = 46，P <.003）。48 个大脚趾中有 18 个（38%）术前有旋前，而 48 个大脚趾中有 2 个（4%）术后有旋前。11 例患者（24%）术前不能做脚趾抬高，46 例患者中有 8 例（17%）术后不能做脚趾抬高。25 例患者（54%）步态改善，19 例患者（44%）步态无变化，2 例患者（4%）步态恶化。术前平均踇外翻角 27 度改善至术后平均 13 度（t = -6.1982，df = 46，P <.001）。术前平均 1-2 跖骨间角 12 度改善至术后平均 9 度（t = -5.2614，df = 46，P <.001）。有 1 例延迟愈合（2%）和 1 例不愈合（2%）。
我们的结果评分表明，使用预弯背侧钛板，在趾骨上使用锁定螺钉，在跖骨上使用非锁定螺钉进行第一跖趾关节融合术，既可靠又可重复，且具有非常高的骨愈合率。
IV 级，前瞻性病例系列。
