Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Foot Ankle Int. 2021 Aug;42(8):1022-1030. doi: 10.1177/10711007211002826. Epub 2021 Apr 10.
Conservative treatment is the first-line approach for Müller-Weiss disease (MWD). However, factors associated with the failure of conservative treatment have never been reported. Our objectives were to compare the differences in demographic and radiographic parameters between "successful" and "failure" conservative treatment in patients with MWD and identify descriptive factors associated with failure conservative treatment.
We retrospectively reviewed 68 patients with MWD divided into 29 "failure" and 39 "successful" conservative treatment groups. Demographic characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores for pain and walking disability, and radiographic parameters such as calcaneal pitch, lateral Meary, anteroposterior (AP) Meary angle, and talonavicular-naviculocuneiform arthritis were compared. Logistic regression analysis was performed to identify descriptive factors of failure conservative treatment. A value <.05 was considered a statistically significant difference.
We found more severe VAS pain and walking disability scores and FAOS for the pain, activities of daily living, and quality of life subscales in the failure group ( < .05). Regression analysis demonstrated 2 significant descriptive factors associated with failure conservative treatment: abducted AP Meary angle >13.0 degrees and radiographic talonavicular arthritis. No demographic characteristics were found to be associated with failure conservative treatment.
Midfoot abduction (AP Meary angle, >13 degrees) and radiographic talonavicular arthritis were factors associated with failure conservative treatment in MWD and should be determined concurrently with the clinical severity. Classification systems for MWD should include these factors.
Level III, retrospective comparative study.
对于 Müller-Weiss 病（MWD），保守治疗是首选方法。然而，从未有报道过与保守治疗失败相关的因素。我们的目的是比较 MWD 患者保守治疗“成功”和“失败”之间的人口统计学和影像学参数差异，并确定与保守治疗失败相关的描述性因素。
我们回顾性分析了 68 例 MWD 患者，分为 29 例“失败”和 39 例“成功”保守治疗组。比较了人口统计学特征、足踝结局评分（FAOS）、疼痛和步行障碍的视觉模拟评分（VAS）以及跟骨倾斜度、外侧 Meary 角、前后（AP）Meary 角和距跟舟楔关节关节炎等影像学参数。采用逻辑回归分析确定保守治疗失败的描述性因素。 <.05 被认为具有统计学意义差异。
我们发现失败组的 VAS 疼痛和步行障碍评分以及 FAOS 的疼痛、日常生活活动和生活质量子量表评分更高（ <.05）。回归分析显示，与保守治疗失败相关的 2 个显著描述性因素为：AP Meary 角外展>13.0 度和影像学距跟舟关节炎。没有发现与保守治疗失败相关的人口统计学特征。
中足外展（AP Meary 角，>13 度）和影像学距跟舟关节炎是 MWD 保守治疗失败的相关因素，应与临床严重程度同时确定。MWD 的分类系统应包括这些因素。
III 级，回顾性比较研究。
