Ahmad Jamal, Lynch Mary-Katherine, Maltenfort Mitchell
1 NorthShore Orthopaedic Institute, NorthShore University Health System, Lincolnshire, IL, USA.
2 Rothman Institute Orthopaedics, Philadelphia, PA, USA.
Foot Ankle Int. 2018 Aug;39(8):922-929. doi: 10.1177/1071100718766658. Epub 2018 Apr 5.
We performed a prospective comparison of screws versus plate-and-screws for midfoot arthrodesis.
Between 2010 and 2015, a total of 50 patients with midfoot arthritis received screws or plate-and-screws for their midfoot arthrodesis. Function and pain were graded with the Foot and Ankle Ability Measures (FAAM) and visual analog scale (VAS), respectively. Data regarding arthrodesis healing and complications were recorded.
Twenty-five patients received screws for fusion, where 21 achieved full arthrodesis healing by 6 months from surgery. Mean FAAM increased from 46.4 to 82.7 of 100 between initial and final visit. Mean pain decreased from 8.3 to 2.1 of 10 between initial and latest encounter. Twenty-five patients received plate-and-screws for their fusion, where 23 achieved full arthrodesis healing by 6 months from surgery. Mean FAAM increased from 48.2 to 86.3 of 100 between initial and final visit. Mean pain decreased from 8.0 to 1.8 of 10 between initial and latest encounter. These postoperative scores were not significantly different from patients with screws ( P > .05). Three and 6 patients with screws versus plate-and-screws, respectively, developed wound complications ( P = .03). Four and 2 patients with screws versus plate-and-screws, respectively, developed delayed or nonunion of their arthrodesis ( P = .15).
A comparison of outcomes of midfoot arthrodesis with screws or plate-and-screws has not been previously reported. Both constructs provide improved function and pain. Using screws might generate less wound complications, but using plate-and-screws might produce higher rates of bony healing.
Level I, randomized, prospective, and comparative cohort study.
我们对用于中足关节融合术的螺钉与钢板螺钉进行了前瞻性比较。
2010年至2015年期间，共有50例中足关节炎患者接受了用于中足关节融合术的螺钉或钢板螺钉治疗。分别采用足踝能力测量量表（FAAM）和视觉模拟量表（VAS）对功能和疼痛进行评分。记录关节融合愈合及并发症的数据。
25例患者接受螺钉融合治疗，其中21例在术后6个月实现了完全关节融合愈合。初次就诊至末次就诊期间，FAAM平均得分从100分中的46.4分提高到82.7分。初次就诊至最近一次就诊期间，平均疼痛评分从10分中的8.3分降至2.1分。25例患者接受钢板螺钉融合治疗，其中23例在术后6个月实现了完全关节融合愈合。初次就诊至末次就诊期间，FAAM平均得分从100分中的48.2分提高到86.3分。初次就诊至最近一次就诊期间，平均疼痛评分从10分中的8.0分降至1.8分。这些术后评分与接受螺钉治疗的患者相比无显著差异（P>.05）。接受螺钉和钢板螺钉治疗的患者分别有3例和6例发生伤口并发症（P = .03）。接受螺钉和钢板螺钉治疗的患者分别有4例和2例发生关节融合延迟或不愈合（P = .15）。
此前尚未报道过中足关节融合术采用螺钉或钢板螺钉治疗效果的比较。两种固定方式均能改善功能并减轻疼痛。使用螺钉可能产生较少的伤口并发症，但使用钢板螺钉可能实现更高的骨愈合率。
I级，随机、前瞻性和比较性队列研究。
