DeSandis Bridget, Ellis Scott J, Levitsky Matthew, O'Malley Quinn, Konin Gabrielle, O'Malley Martin J
Hospital for Special Surgery, New York, NY, USA.
Hospital for Special Surgery, New York, NY, USA
Foot Ankle Int. 2015 Oct;36(10):1190-5. doi: 10.1177/1071100715585560. Epub 2015 May 12.
Current literature reports excellent rates of union following various lesser metatarsal osteotomy techniques. However, it is our experience that segmental midshaft shortening osteotomies heal very slowly and have a greater potential for nonunion than has previously been reported. The purpose of this study was to assess union rates and report the time required for segmental midshaft shortening osteotomies to achieve radiographic union.
We reviewed the charts and postoperative radiographs of 58 patients (representing 91 osteotomies) who underwent segmental midshaft shortening osteotomies with internal fixation between January 2009 and December 2013. Radiographs were reviewed to determine when union was achieved. Union was defined as the bridging of 2 or more cortices in the anteroposterior, lateral, and oblique radiographic views. Osteotomies were classified as delayed union if they were not healed at 3 months postoperatively and nonunions if they were not healed at 6 months postoperatively.
Overall, 27 of 91 osteotomies met our radiographic classification of union and were healed by 3 months (29.7%). Sixty-nine of the 91 osteotomies healed by 6 months (75.8%) and were considered delayed unions. Twenty-two osteotomies were not healed yet and therefore were considered nonunions (24.2%). Of the 22 nonunions, 7 healed in an additional 2 months (8 months) for an overall healing percentage of 83.5%, (76 of 91). By 10 months, 6 more nonunions were healed (overall healing percentage of 90.1%, 82 of 91). Three additional nonunions went on to heal by 12.9 months, yielding a final union rate of 93.4% (85 of 91), while 6 were still considered nonunions (6.6%).
We report that a significant percentage of segmental midshaft metatarsal shortening osteotomies experienced delayed unions and nonunions. These findings contrast those previously reported in the literature that metatarsal osteotomies have very low nonunion rates. These results support our hypothesis that these osteotomies require a prolonged amount of time to achieve bony healing and that they have a higher tendency to develop delayed and nonunions than previously reported.
Level IV, retrospective case series.
当前文献报道了各种较小跖骨截骨术术后的良好愈合率。然而，根据我们的经验，节段性骨干缩短截骨术愈合非常缓慢，且骨不连的可能性比之前报道的更大。本研究的目的是评估愈合率，并报告节段性骨干缩短截骨术实现影像学愈合所需的时间。
我们回顾了2009年1月至2013年12月期间接受节段性骨干缩短截骨术并进行内固定的58例患者（共91处截骨）的病历和术后X线片。通过复查X线片来确定何时实现愈合。愈合定义为在前后位、侧位和斜位X线片上有2个或更多皮质骨桥接。术后3个月未愈合的截骨被分类为延迟愈合，术后6个月未愈合的则被分类为骨不连。
总体而言，91处截骨中有27处符合我们的影像学愈合分类，并在3个月时愈合（29.7%）。91处截骨中有69处在6个月时愈合（75.8%），被视为延迟愈合。22处截骨尚未愈合，因此被视为骨不连（24.2%）。在这22处骨不连中，7处又在额外的2个月（即8个月时）愈合，总体愈合率为83.5%（91处中的76处）。到10个月时，又有6处骨不连愈合（总体愈合率为90.1%，91处中的82处）。另外3处骨不连在12.9个月时愈合，最终愈合率为93.4%（91处中的85处），而仍有6处被视为骨不连（6.6%）。
我们报告节段性跖骨干缩短截骨术有相当比例出现延迟愈合和骨不连。这些发现与文献中先前报道的跖骨截骨术骨不连率非常低的情况形成对比。这些结果支持了我们的假设，即这些截骨术需要较长时间才能实现骨愈合，并且它们发生延迟愈合和骨不连的倾向比先前报道的更高。
IV级，回顾性病例系列。
