Department of Orthopaedic Surgery, Elche University Hospital, Elche, Alicante, Spain.
Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain.
Foot Ankle Int. 2021 Apr;42(4):425-430. doi: 10.1177/1071100720968831. Epub 2020 Nov 3.
The purpose of this study was to compare the clinical outcomes after first metatarsophalangeal (MTP) joint arthrodesis for hallux rigidus between patients who underwent primary arthrodesis and those who had had a prior surgery for hallux valgus.
Our design was a retrospective cohort study comparing 29 patients who underwent primary arthrodesis (primary group) and 34 patients with hallux rigidus after hallux valgus surgery (secondary group). The clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score and a visual analog scale (VAS) for pain. Radiological evaluation was also performed. Overall, the mean postoperative follow-up was 3.4 (range, 2-5) years.
At final follow-up, AOFAS and VAS pain scores significantly improved in both groups ( = .001). However, the mean AOFAS ( = .001) and VAS pain ( = .008) scores were significantly better in the primary group than in the secondary group. Radiologically, there were no significant differences between the groups in any angle after arthrodesis. Revision surgeries were not required in the primary group. In the secondary group, there was 1 revision due to deep infection, and 3 other patients required dorsal plate removal. Excluding plate removal, the Kaplan-Meier survival at 3 years was not significantly different between groups ( = .775).
Although arthrodesis of the first MTP joint was an effective procedure for hallux rigidus, the clinical outcomes in patients who had prior hallux valgus surgery were worse than those for patients who underwent primary surgery for hallux rigidus.
Level III, retrospective cohort study.
本研究旨在比较拇僵硬初次跖趾（MTP）关节融合术与拇外翻术后行初次融合术患者的临床疗效。
本研究采用回顾性队列设计，比较了 29 例初次融合术（初次组）和 34 例拇外翻术后拇僵硬患者（二次组）。临床评估包括美国矫形足踝协会（AOFAS）评分和疼痛视觉模拟评分（VAS）。所有患者的平均术后随访时间为 3.4（2-5）年。
末次随访时，两组 AOFAS 和 VAS 疼痛评分均显著改善（均 P<.001）。然而，初次组的平均 AOFAS（P<.001）和 VAS 疼痛评分（P<.008）明显优于二次组。影像学方面，两组融合后各角度均无显著差异。初次组无翻修手术，二次组中 1 例因深部感染行翻修，3 例需行背侧钢板取出。不包括钢板取出，两组 3 年 Kaplan-Meier 生存率无显著差异（P=.775）。
尽管第一跖趾关节融合术是治疗拇僵硬的有效方法，但对于有拇外翻病史的患者，其临床疗效不如初次手术治疗拇僵硬的患者。
III 级，回顾性队列研究。
