Derner Richard, Derner Brian S, Olsen Ansgar
Residency Program Director, Inova Medical Center, Fairfax, VA.
Second Year Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Denver, CO.
J Foot Ankle Surg. 2020 Jul-Aug;59(4):704-710. doi: 10.1053/j.jfas.2019.12.004. Epub 2020 Mar 31.
The literature has previously criticized lateral column arthrodesis, stating this procedure should be avoided to preserve biomechanical function. For patients with recurrent pain secondary to posttraumatic degenerative joint disease (PT-DJD) or dysfunction secondary to Charcot tarsometatarsal collapse, however, this procedure could provide a positive alternative to conservative measures. In our study, 37 patients underwent fourth and/or fifth metatarsal to cuboid arthrodesis, either in isolation or in combination with other tarsometatarsal arthrodeses, with an average follow-up of 27.7 ± 28.5 months. Of the 37 patients, 4 (10.8%) had purely isolated lateral column arthrodesis procedures, and 33 (89.2%) had additional fusions. Twenty patients (54.0%) were in the Charcot neuroarthropathy cohort and 17 (45.9%) in PT-DJD. Radiographs were reviewed to confirm osseous union and measure the lateral column position in both sagittal and transverse planes, using radiographic angles to measure angular correction in the transverse and sagittal planes. Postoperative patient satisfaction outcome measures were obtained via written survey, and 10-cm visual analog scale (VAS) was scored pre- and postoperatively. There was a statistically significant reduction in pain postoperatively (p < .001) and an 89% patient satisfaction rate. The incidence of revision for osseous nonunion was 10.8%. Our study shows that lateral column arthrodesis, either in isolation or combination, provides significant pain relief, high patient satisfaction, and a low incidence of revision per previous literature. This challenges past evidence-based medicine regarding lateral column fusions. The surgical procedures completed in this study suggest reproducible results with a low revision rates and high patient satisfaction for lateral column arthrodesis.
此前文献曾对外侧柱关节融合术提出批评，称应避免该手术以保留生物力学功能。然而，对于创伤后退行性关节病（PT-DJD）继发复发性疼痛或夏科氏跗跖关节塌陷继发功能障碍的患者，该手术可为保守治疗提供积极的替代方案。在我们的研究中，37例患者接受了第四和/或第五跖骨至骰骨关节融合术，可单独进行，也可与其他跗跖关节融合术联合进行，平均随访时间为27.7±28.5个月。在这37例患者中，4例（10.8%）仅接受了单纯的外侧柱关节融合术，33例（89.2%）还进行了其他融合术。20例（54.0%）患者属于夏科氏神经关节病队列，17例（45.9%）属于PT-DJD队列。复查X线片以确认骨愈合情况，并测量矢状面和横断面的外侧柱位置，使用X线角度测量横断面上的角度矫正和矢状面上的角度矫正。通过书面调查获得术后患者满意度结果指标，并在术前和术后对10厘米视觉模拟量表（VAS）进行评分。术后疼痛有统计学意义的显著减轻（p<0.001），患者满意度为89%。骨不连翻修率为10.8%。我们的研究表明，单独或联合进行外侧柱关节融合术，均可显著缓解疼痛，患者满意度高，且根据以往文献，翻修率低。这对过去关于外侧柱融合术的循证医学证据提出了挑战。本研究中完成的手术显示，外侧柱关节融合术具有可重复的结果，翻修率低，患者满意度高。
