Mayer Stephanie A, Zelenski Nicole A, DeOrio James K, Easley Mark E, Nunley James A
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Foot Ankle Int. 2014 May;35(5):438-44. doi: 10.1177/1071100714520695. Epub 2014 Feb 5.
First metatarsophalangeal (MTP) joint arthrodesis is a successful, commonly performed procedure for many conditions affecting this joint. The purpose of this retrospective study was to compare the clinical and radiographic outcomes between patients who had primary first MTP joint fusions with either noncontoured stainless steel semitubular plates or precontoured plates. Our hypothesis was that there would be no difference in clinical or radiographic outcomes between these groups.
A search based on operative report coding was performed to detect all patients who had undergone primary first MTP joint arthrodesis with a dorsal plating construct at our institution from 2005 to 2010. A retrospective review of electronic medical records and postoperative radiographs was performed to determine time to clinical and radiographic union, pain scores, complications, MTP angle, and proximal phalanx to floor angle. A Kruskal-Wallis test was used for continuous variables, and a chi-square or Fisher exact test was used for categorical variables to determine statistical significance between the 2 groups.
We identified 128 patients who met our inclusion criteria. One hundred and two feet in 97 patients underwent arthrodesis with a noncontoured, stainless steel 1/3 tubular plate (group 1) and 26 feet in 21 patients with a precontoured, locking plate (group 2). The patients presented with a variety of inflammatory and noninflammatory preoperative diagnoses. The overall union rate, complication rate, time to radiographic healing, MTP angle, and patient-reported visual analog scale (VAS) score were similar between the 2 groups. Clinical time to healing was more rapid in the noncontoured group (3.7 months vs 4.8 degrees in precontoured) (P = .02). The radiographically measured proximal phalanx to floor angle was significantly decreased in noncontoured patients (2.6 degrees vs 4.6 degrees in precontoured, P = .04). In patients who had a diagnosis of an inflammatory arthropathy, the union rate fell to 84.3% (27/32) in the noncontoured group and 87.5% (7/8) in the precontoured group, and time to radiographic as well as clinical union increased in both groups. When patients with inflammatory arthropathies were compared with noninflammatory patients within groups, it was found that the time to both clinical and radiographic union was significantly longer in the noncontoured group for those with an inflammatory arthropathy (P = .0052, P = .022). For the precontoured group, these values were not statistically significant (P = .089, P = .43). Additionally, the cost of the noncontoured implants was significantly less than that of the precontoured implants.
In this study, clinical time to healing of primary first MTP fusion with dorsal plate and screw constructs was improved with the use of noncontoured plates. However, other clinical indicators such as pain, complication rate, MTP angle, and VAS score did not differ between groups. Noncontoured plates are less expensive, and thus the decision to use precontoured plates routinely should be made cautiously. However, in the presence of inflammatory arthropathy, the use of precontoured plates may be justified given that the use of these plates in the inflammatory group resulted in improved radiographic and clinical union.
Level III, comparative series.
第一跖趾关节融合术是治疗该关节多种疾病的一种成功且常用的手术。本回顾性研究的目的是比较采用非塑形不锈钢半管状钢板或预塑形钢板进行初次第一跖趾关节融合术的患者的临床和影像学结果。我们的假设是这两组患者的临床和影像学结果无差异。
通过基于手术报告编码的检索，找出2005年至2010年在我们机构接受初次第一跖趾关节融合术并采用背侧钢板固定的所有患者。对电子病历和术后X线片进行回顾性分析，以确定临床和影像学愈合时间、疼痛评分、并发症、跖趾角以及近节趾骨与地面夹角。连续变量采用Kruskal-Wallis检验，分类变量采用卡方检验或Fisher精确检验来确定两组间的统计学差异。
我们确定了128例符合纳入标准的患者。97例患者的102足采用非塑形不锈钢1/3管状钢板进行融合术（第1组），21例患者的26足采用预塑形锁定钢板（第2组）。患者术前有多种炎性和非炎性诊断。两组的总体愈合率、并发症发生率、影像学愈合时间、跖趾角以及患者报告的视觉模拟量表（VAS）评分相似。非塑形钢板组的临床愈合时间更快（3.7个月对比预塑形钢板组的4.8个月）（P = 0.02）。非塑形钢板组患者的影像学测量的近节趾骨与地面夹角显著降低（2.6度对比预塑形钢板组的4.6度，P = 0.04）。诊断为炎性关节病的患者中，非塑形钢板组的愈合率降至84.3%（27/32），预塑形钢板组为87.5%（7/8），两组的影像学和临床愈合时间均增加。当将炎性关节病患者与组内非炎性患者进行比较时，发现非塑形钢板组炎性关节病患者的临床和影像学愈合时间均显著更长（P = 0.0052，P = 0.022）。对于预塑形钢板组，这些值无统计学意义（P = 0.089，P = 0.43）。此外，非塑形植入物的成本显著低于预塑形植入物。
在本研究中，采用非塑形钢板可改善初次第一跖趾关节融合术采用背侧钢板和螺钉固定的临床愈合时间。然而，疼痛、并发症发生率、跖趾角和VAS评分等其他临床指标在两组间并无差异。非塑形钢板成本更低，因此常规使用预塑形钢板的决定应谨慎做出。然而，在存在炎性关节病的情况下，鉴于在炎性组使用这些钢板可改善影像学和临床愈合，使用预塑形钢板可能是合理的。
III级，比较性系列研究。
