Luk Pamela C, Johnson Jeffrey E, McCormick Jeremy J, Klein Sandra E
Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA Congress Medical Associates, Arcadia, CA, USA.
Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
Foot Ankle Int. 2015 Aug;36(8):936-43. doi: 10.1177/1071100715577953. Epub 2015 Apr 6.
We present a technique of first metatarsophalangeal joint arthrodesis utilizing an interposition allograft bone block with a bipolar reaming technique that creates congruent fusion surfaces on both ends of the graft-host bone interface. In addition, we examined the union rates, fusion position, patient satisfaction, and functional outcome of this technique.
Fifteen patients underwent first metatarsophalangeal joint arthrodesis with an interposition allograft bone block between September 2004 and October 2013. Charts and radiographs were reviewed. Six measures were compared on preoperative and postoperative radiographs. Clinical outcomes were measured using a telephone questionnaire, pre- and postoperative visual analog scale pain scale, and Foot and Ankle Ability Measure. Average follow-up was 46 weeks (range, 19 to 97).
Thirteen of 15 (87%) patients achieved bony union at an average of 21 weeks. One patient underwent revision arthrodesis for their nonunion. Symptomatic hardware was removed in 3 cases. Improvement was noted in visual analog scale pain scores (6 to 2) and functional scores as measured by the Foot and Ankle Ability Measure. There were no postoperative wound complications or infections. Average length of the first ray on anteroposterior radiograph increased from 10.7 to 11.3 cm and from 10.0 to 10.7 cm on the lateral radiograph. Thirteen of 14 patients were very satisfied or satisfied. One patient expressed dissatisfaction with the procedure. One patient was not available for clinical follow-up.
First metatarsophalangeal joint allograft bone block arthrodesis using the bipolar reaming technique achieved high bony union rates and satisfactory radiographic and clinical outcomes. This procedure was an effective salvage option for managing bone loss on 1 or both sides of the joint.
Level IV, retrospective case series.
我们介绍一种第一跖趾关节融合术技术，该技术利用同种异体骨植入块并采用双极扩孔技术，在移植骨与宿主骨界面的两端形成贴合的融合面。此外，我们还研究了该技术的骨愈合率、融合位置、患者满意度和功能结果。
2004年9月至2013年10月期间，15例患者接受了使用同种异体骨植入块的第一跖趾关节融合术。回顾了病历和X线片。对术前和术后X线片的六项指标进行了比较。使用电话问卷、术前和术后视觉模拟评分疼痛量表以及足踝能力测量来评估临床结果。平均随访时间为46周（范围19至97周）。
15例患者中有13例（87%）平均在21周时实现了骨性愈合。1例患者因骨不连接受了翻修融合术。3例患者取出了引起症状的内固定物。视觉模拟评分疼痛分数（从6分降至2分）以及通过足踝能力测量得出的功能分数均有改善。术后无伤口并发症或感染。前后位X线片上第一跖骨的平均长度从10.7 cm增加到11.3 cm，侧位X线片上从10.0 cm增加到10.7 cm。14例患者中有13例非常满意或满意。1例患者对手术表示不满意。1例患者无法进行临床随访。
采用双极扩孔技术的第一跖趾关节同种异体骨植入块融合术实现了较高的骨性愈合率以及令人满意的影像学和临床结果。该手术是处理关节一侧或双侧骨质缺损的有效挽救性选择。
IV级，回顾性病例系列。
