Fazal Muhammad Ali, Wong Jason Hol-Ming, Rahman Luthfur
Royal Free Hospitals London NHS Foundation Trust, The Ridgeway, Enfield, United Kingdom.
Department of Trauma & Orthopaedics, Royal Free Hospitals London NHS Foundation Trust, The Ridgeway, Enfield, United Kingdom.
Acta Orthop Traumatol Turc. 2018 Sep;52(5):363-366. doi: 10.1016/j.aott.2018.06.008. Epub 2018 Aug 11.
First MTP joint fusion is a reliable procedure for advanced arthritis for the first MTP joint. There are many techniques described. The purpose of our study is to report clinical, radiological, functional outcomes and complications of first metatarsophalangeal joint fusion with hand preparation of the joint and fixation with two orthogonal locking plates without a compression screw.
32 feet in 26 consecutive patients under went first metatarsophalangeal joint fusion with above technique. There were 23 women and 3 men. Mean age was 64 years and mean follow-up was 49 months. 21 patients had osteoarthritis, 10 had rheumatoid arthritis and one had psoriatic arthritis. Clinical, radiological, American Orthopaedic Foot and Ankle Score and Foot and Ankle Disability Index clinical rating scales were used for evaluation.
Fusion was achieved in 27 feet. The incidence of radiological non-union was 15.7%. Mean AOFAS score improved from 37.1 to 80.7 (p < 0.0001) and mean FADI score improved from 40.3 to 86.9 postoperatively (p < 0.0001). Two patients with osteoarthritis and three with Rheumatoid arthritis did not unite. Four of these patients were managing hence revision surgery was not carried out but had low AOFAS and FADI scores. One patient with symptomatic non-union declined further surgery. One patient needed plate removal for a low grade infection and reoperation rate was 3.1%.
In our experience, first metatarsophalangeal joint arthrodesis using two orthogonal two hole plates without a compression screw is associated with a higher non-union rate in our cohort hence we do not recommend this technique.
Level IV, therapeutic study.
第一跖趾关节融合术是治疗第一跖趾关节晚期关节炎的可靠手术方法。目前已有多种技术被描述。本研究的目的是报告采用关节手工准备及两枚正交锁定钢板固定（无加压螺钉）进行第一跖趾关节融合术的临床、影像学、功能结果及并发症。
26例连续患者的32足接受了上述技术的第一跖趾关节融合术。其中女性23例，男性3例。平均年龄64岁，平均随访49个月。21例患者患有骨关节炎，10例患有类风湿关节炎，1例患有银屑病关节炎。采用临床、影像学、美国矫形足踝协会评分（AOFAS）以及足踝残疾指数（FADI）临床评定量表进行评估。
27足实现融合。影像学骨不连发生率为15.7%。术后平均AOFAS评分从37.1提高到80.7（p<0.0001），平均FADI评分从40.3提高到86.9（p<0.0001）。2例骨关节炎患者和3例类风湿关节炎患者未实现融合。其中4例患者病情稳定，因此未进行翻修手术，但AOFAS和FADI评分较低。1例有症状性骨不连的患者拒绝进一步手术。1例患者因轻度感染需要取出钢板，再手术率为3.1%。
根据我们经验，在本队列中，使用两枚无加压螺钉的正交双孔钢板进行第一跖趾关节融合术的骨不连发生率较高，因此我们不推荐该技术。
IV级，治疗性研究。
