King Christy M, Richey Johanna, Patel Sandeep, Collman David R
Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Foundation Hospital, Oakland, CA.
Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Foundation Hospital, Walnut Creek, CA.
J Foot Ankle Surg. 2015 Jan-Feb;54(1):69-75. doi: 10.1053/j.jfas.2014.09.034. Epub 2014 Oct 31.
Modified Lapidus arthrodesis is a versatile and powerful procedure for correcting the hallux valgus deformity typically associated with significant metatarsus primus varus or increased first ray mobility. Traditionally, patients have remained non-weightbearing until the arthrodesis has consolidated. More recently, numerous studies have evaluated the outcomes of early postoperative weightbearing using a variety of fixation constructs. The present retrospective cohort study evaluated 136 consecutive patients who had undergone modified Lapidus arthrodesis for hallux valgus deformity with conventional, crossed, solid core, screw fixation, were enrolled in an early weightbearing protocol, and were followed for 12 months. All the patients were partial weightbearing in a protective boot a mean of 12.2 (SD ± 4.36) days after surgery, with full weightbearing at 34.4 (SD ± 11.89) days. Union was achieved in 133 patients (97.8%). Of the 3 (2.2%) patients with nonunion, 2 (1.5%) remained asymptomatic. The mean time to radiographic union was 65 (SD ± 37.24) days. Significant improvement was seen in the first intermetatarsal angle and hallux abductus angle after surgery (p < .0001). Deformity correction was not compromised by early weightbearing and was well maintained over time. These results support early weightbearing with traditional crossed screw fixation for modified Lapidus arthrodesis with outcomes and complication rates comparable to those previously published.
改良Lapidus关节融合术是一种多功能且有效的手术方法，用于矫正通常与严重的第一跖骨内翻或第一跖骨活动度增加相关的拇外翻畸形。传统上，患者在关节融合术巩固之前一直不负重。最近，许多研究使用各种固定结构评估了术后早期负重的结果。本回顾性队列研究评估了136例连续接受改良Lapidus关节融合术治疗拇外翻畸形的患者，这些患者采用传统的交叉实心髓内螺钉固定，纳入早期负重方案，并随访12个月。所有患者术后平均12.2（标准差±4.36）天在保护性靴内部分负重，34.4（标准差±11.89）天完全负重。133例患者（97.8%）实现了骨愈合。在3例（2.2%）未愈合的患者中，2例（1.5%）无症状。影像学骨愈合的平均时间为65（标准差±37.24）天。术后第一跖骨间角和拇外展角有显著改善（p <.0001）。早期负重并未影响畸形矫正，且随着时间的推移保持良好。这些结果支持改良Lapidus关节融合术采用传统交叉螺钉固定进行早期负重，其结果和并发症发生率与先前发表的结果相当。
