Singhal Rohit, Kwaees Tariq, Mohamed Mohamed, Argyropoulos Miltiadis, Amarasinghe Pradeep, Toh E M
Mersey Deanery, Health Education North West, Liverpool, United Kingdom.
Mersey Deanery, Health Education North West, Liverpool, United Kingdom.
Foot Ankle Surg. 2018 Oct;24(5):466-470. doi: 10.1016/j.fas.2017.05.003. Epub 2017 Jun 1.
Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a common procedure to treat significant first MTPJ arthritis. However, dorsal plates used for this have been associated with high incidence of metalwork removal. The IOFIX (Intra-Osseous FIXation) is a fixed angle device that is noted to provide a more uniform compression over a larger aspect of the fusion surfaces than a screw construct alone with the advantage of minimizing soft tissue irritation which can reduce the need for subsequent implant removal.
Twenty one consecutive patients who underwent primary first MTPJ fusion with the IOFIX were reviewed. The mean age of the cohort was 63 years (range 47-81), with 80% female. The ratio of left to right was 9:12. The mean follow up of was 28 months (range 13.4-48.2 months). Outcomes analyzed were rate of fusion, Manchester-Oxford foot questionnaire (MOXFQ) score, patient satisfaction, improvement in the intermetatarsal angle and complications.
Complete fusion of the first MTPJ was achieved in twenty (95%) patients. One patient had a non union and another patient developed a delayed union. The mean preoperative MOXFQ score improved from 49.7 (95% confidence interval: 46-52) to 17.9 (95% confidence interval: 12-22), p<0.05.Improvement gained in all the domains of the MOXFQ score (walking/standing, pain and social) was statistically significant (p<0.05). Eighteen out of 21 patients (85%) were very pleased or fairly pleased with the procedure.
Early results show that the rate of fusion achieved by using the IOFIX device for the first MTPJ arthrodesis in our series was found to be comparable to other devices quoted in the literature.
第一跖趾关节（MTPJ）融合术是治疗严重的第一跖趾关节关节炎的常见手术。然而，用于此手术的背侧板与较高的金属植入物取出率相关。IOFIX（骨内固定）是一种固定角度装置，与单独的螺钉结构相比，它能在融合面的更大区域提供更均匀的加压，其优点是能将软组织刺激降至最低，从而减少后续植入物取出的必要性。
回顾了连续21例行IOFIX初次第一跖趾关节融合术的患者。该队列的平均年龄为63岁（范围47 - 81岁），女性占80%。左右比例为9:12。平均随访时间为28个月（范围13.4 - 48.2个月）。分析的结果包括融合率、曼彻斯特 - 牛津足部问卷（MOXFQ）评分、患者满意度、跖间角改善情况及并发症。
20例（95%）患者实现了第一跖趾关节的完全融合。1例患者出现骨不连，另1例患者出现延迟愈合。术前MOXFQ评分的平均值从49.7（95%置信区间：46 - 52）提高到17.9（95%置信区间：12 - 22），p<0.05。MOXFQ评分所有领域（行走/站立、疼痛和社交）的改善均具有统计学意义（p<0.05）。21例患者中有18例（85%）对该手术非常满意或比较满意。
早期结果表明，在我们的系列研究中，使用IOFIX装置进行第一跖趾关节融合术的融合率与文献中引用的其他装置相当。
