1 Foot and Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
2 Department of Trauma and Orthopedic Surgery, S. Anna Hospital, University of Ferrara, Ferrara, Italy.
Foot Ankle Int. 2018 Dec;39(12):1394-1402. doi: 10.1177/1071100718793567. Epub 2018 Sep 1.
: End-stage tarsometatarsal (TMT) arthritis is commonly treated with arthrodesis of involved joints. Fixation hardware can consist of varying combinations of screws, plates, and staples with or without supplemental bone graft. There are limited data to demonstrate either superiority of a given fixation method or the impact of bone graft on fusion rates. The purpose of this study, therefore, was to determine whether nonunion rates after TMT arthrodesis were influenced by either the use of screw vs plate fixation or the addition of bone graft vs no bone graft.
: All patients older than 18 years undergoing arthrodesis for TMT arthritis between July 1991 and July 2016 were identified retrospectively. Exclusion criteria included less than 12 months follow-up, prior midfoot surgery, any added procedure beyond TMT arthrodesis using plates or screws, and acute foot trauma. All patients with radiographic or clinical nonunion, including those requiring revision surgery, were identified. Demographic data and associated risk factors were recorded via chart and radiographic image review. Eighty-eight patients (88 feet, mean follow-up: 75.1 ± 51.4; range, 12-179), with a total of 189 joints and who met enrollment criteria were treated by 9 different surgeons with arthrodesis.
: The overall nonunion rate was 11.4%. Significant independent risk factors associated with nonunion were (1) arthrodesis using plate fixation with all screws through the plate (odds ratio [OR], 6.2; 95% confidence interval [CI], 1.8-21.3; P = .004), (2) smoking during the perioperative period (OR, 7.9; 95% CI, 2.1-30.2; P = .002), and (3) postoperative nonanatomic alignment (OR, 11.2; 95% CI, 2.1-60.8; P = .005). Bone graft utilization was found to significantly lower the rate of nonunion (OR, 0.2; 95% CI, 0.1-0.6; P = .006).
: Isolated plate fixation, smoking, and postoperative nonanatomic alignment appear to significantly increase the rate of nonunion among patients undergoing TMT arthrodesis for midfoot arthritis. Concomitant use of autogenous bone graft significantly decreased this risk.
: Level III, retrospective comparative study.
终末期跗跖关节（TMT）关节炎通常采用受累关节融合术治疗。固定硬件可以由不同组合的螺钉、钢板和钉书钉组成，也可以带有或不带有补充骨移植物。目前的数据有限，无法证明特定固定方法的优越性或骨移植物对融合率的影响。因此，本研究的目的是确定 TMT 融合术后不愈合率是否受螺钉与钢板固定、骨移植物与非骨移植物的使用的影响。
回顾性确定 1991 年 7 月至 2016 年 7 月间因 TMT 关节炎接受融合术的所有年龄大于 18 岁的患者。排除标准包括随访时间少于 12 个月、既往中足手术、除 TMT 融合术之外使用钢板或螺钉的任何附加手术、以及急性足部创伤。通过图表和影像学图像回顾记录所有影像学或临床不愈合的患者，包括需要翻修手术的患者。记录人口统计学数据和相关的危险因素。共有 9 位不同的外科医生采用融合术治疗了 88 例患者（88 只脚，平均随访 75.1 ± 51.4 个月，范围为 12-179 个月），共涉及 189 个关节，并且符合入组标准。
总的不愈合率为 11.4%。与不愈合显著相关的独立危险因素包括（1）使用钢板固定，所有螺钉均穿过钢板（比值比[OR]，6.2；95%置信区间[CI]，1.8-21.3；P =.004）；（2）围手术期吸烟（OR，7.9；95% CI，2.1-30.2；P =.002）；（3）术后非解剖对线（OR，11.2；95% CI，2.1-60.8；P =.005）。骨移植物的使用显著降低了不愈合率（OR，0.2；95% CI，0.1-0.6；P =.006）。
对于因中足关节炎接受 TMT 融合术的患者，单纯的钢板固定、吸烟和术后非解剖对线似乎会显著增加不愈合率。同时使用自体骨移植物可显著降低这种风险。
III 级，回顾性比较研究。
