Resident, Department of Orthopedic Surgery, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark; Resident, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark.
Foot and Ankle Surgeon, Department of Orthopedic Surgery, Aleris-Hamlet Hospitals, Søborg, Denmark.
J Foot Ankle Surg. 2021 Mar-Apr;60(2):322-327. doi: 10.1053/j.jfas.2020.10.010. Epub 2020 Nov 4.
Hallux rigidus can be treated with a proximal hemiarthroplasty (HemiCAP®) to preserve the motion in the first metatarsophalangeal joint and reduce pain. This study examines the functionality, and survival rates of HemiCAP® implants, with or without a dorsal flange. One hundred and five patients were treated with a HemiCAP® (N = 116 HemiCAPs®) between 2006 and 2014. Revision rates, arthrosis score, hallux valgus (HV), intermetatarsal (IM), distal metaphyseal articular angle (DMAA), visual analog scale (VAS) (1-10 points), American Orthopaedic Foot and Ankle Score (AOFAS) MTP-IP (AOFAS 0-100 points), SF-12, range of motion (ROM), and radiographs were analyzed pre- and postoperatively. Statistics: Kaplan-Meier survival analysis, Cox-regression, and paired t tests. At 2, 4, and 6 years, the implant survival was 87%, 83%, and 81%, respectively. All revised due to pain. Dorsal flange, gender, arthrosis, HV, IM, and DMAA did not influence the results. At the mean 5-year follow-up (n = 47) median (range) dorsal ROM was 45° (10°-75°), AOFAS was mean 87.2 ± 10.8, VAS was 2 ± 1.6, and SEFAS was 42 ± 6 points. The dorsal flange made no significant difference for ROM or patient-reported outcome measures compared to the HemiCAP® with no dorsal flange. Twenty-three patients with preoperative data were re-examined, and preoperative dorsal ROM mean difference (confidence interval [CI]) increased 20.7° (13.9°-27.4°), VAS decreased with a mean difference (CI) of -4.7 (-5.8 to 3.5), and AOFAS increased with a mean difference (CI) 26.2 (20.2-32.2) (for all p < .001). The 6-year survival rate of the HemiCAP® implant was 81%. The design change to dorsal flange was not evident clinically. Unrevised patients had significantly less pain, greater ROM, and better foot and ankle function than preoperatively.
拇僵硬可以采用近端半关节成形术（HemiCAP®）治疗，以保留第一跖趾关节的活动度并减轻疼痛。本研究检查了 HemiCAP®植入物有无背侧翼的功能和存活率。2006 年至 2014 年间，105 例患者接受了 HemiCAP®（N=116 个 HemiCAP®）治疗。翻修率、关节炎评分、拇外翻（HV）、跖间（IM）、远侧干骺端关节角（DMAA）、视觉模拟评分（VAS）（1-10 分）、美国矫形足踝协会评分（AOFAS MTP-IP）（AOFAS 0-100 分）、SF-12、活动范围（ROM）和 X 线片在术前和术后进行了分析。统计学方法：Kaplan-Meier 生存分析、Cox 回归和配对 t 检验。2、4 和 6 年时，植入物的存活率分别为 87%、83%和 81%。所有因疼痛而翻修。背侧翼、性别、关节炎、HV、IM 和 DMAA 对结果没有影响。在平均 5 年的随访（n=47）中，中位数（范围）背侧 ROM 为 45°（10°-75°），AOFAS 平均为 87.2±10.8，VAS 为 2±1.6，SEFAS 为 42±6 分。与无背侧翼的 HemiCAP®相比，背侧翼对 ROM 或患者报告的结果测量无显著差异。对 23 例有术前数据的患者进行了重新检查，术前背侧 ROM 平均差值（置信区间 [CI]）增加 20.7°（13.9°-27.4°），VAS 平均差值（CI）下降 4.7（-5.8 至 3.5），AOFAS 平均差值（CI）增加 26.2（20.2-32.2）（均 p<.001）。HemiCAP®植入物的 6 年存活率为 81%。背侧翼的设计改变在临床上并不明显。未翻修患者的疼痛明显减轻，ROM 更大，足踝功能更好。
