Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Foot Ankle Spec. 2024 Apr;17(2):98-108. doi: 10.1177/19386400211032482. Epub 2021 Aug 2.
Midfoot arthrodesis is a common procedure performed both for arthritis and correction of deformity. The optimal fixation for midfoot arthrodesis has not been established, though numerous studies have been investigating the fixation techniques of midfoot arthrodesis. The purpose of this study was to compare the union rate of midfoot arthrodesis using 4 different fixation strategies and investigate risk factors of nonunion following midfoot arthrodesis.
A retrospective chart review was performed for patients who underwent midfoot joint arthrodesis between January 2014 and May 2019. The rates of nonunion and postoperative complication were compared among 4 different fixation constructs: staple fixation, compression plate fixation, compression plate with lag screw fixation, and compression screw fixation. Predictors of nonunion following midfoot arthrodesis were investigated through a multivariable logistic regression analysis. A total of 95 patients (99 feet), including 240 midfoot joints were included in this study. The mean follow-up period was 78.4 weeks.
Overall, bony union was achieved in 86 out of 99 (86.9%) patients, which included 218 out of 240 (90.8%) midfoot joints. A significant difference in the nonunion rate according to the type of fixation construct was found ( = .011); the compression screw alone fixation construct was noted to have a significantly higher nonunion rate than other fixation constructs. Diabetes mellitus (odds ratio [OR] = 0.179 [95% CI: 0.059, 0.542]), the type of fixation construct (compression screw alone; OR =1.789 [95% CI: 1.071, 2.978]), lack of adjuvant bone graft (OR = 2.803 [95% CI: 1.081, 7.268], and postoperative nonanatomical alignment (OR = 3.937 [95% CI: 1.278, 12.126]) were identified as independent predictors of nonunion following midfoot arthrodesis.
The rate of nonunion following midfoot arthrodesis among 4 different commonly used fixation constructs was compared in this study. Risk factors of nonunion were investigated revealing that diabetes mellitus, compression screw fixation alone, lack of adjuvant bone graft, and postoperative nonanatomical alignment are independent predictors of nonunion following midfoot arthrodesis.
Level III: Comparative cohort study.
中跗关节融合术是一种常见的用于治疗关节炎和矫正畸形的手术。尽管已有许多研究探讨了中跗关节融合术的固定技术，但对于中跗关节融合术的最佳固定方法尚未确定。本研究的目的是比较使用 4 种不同固定策略的中跗关节融合术的融合率，并探讨中跗关节融合术后不愈合的危险因素。
对 2014 年 1 月至 2019 年 5 月期间接受中跗关节融合术的患者进行回顾性病历分析。比较 4 种不同固定结构（钢钉固定、加压钢板固定、加压钢板加拉力螺钉固定、加压螺钉固定）的不愈合率，并通过多变量逻辑回归分析探讨中跗关节融合术后不愈合的预测因素。本研究共纳入 95 例（99 足），240 个中跗关节。平均随访时间为 78.4 周。
总体而言，86 例（86.9%）患者达到骨性融合，其中 218 例（90.8%）中跗关节达到骨性融合。不同固定结构的不愈合率有显著差异（ =.011）；单独使用加压螺钉固定的结构不愈合率明显高于其他固定结构。糖尿病（比值比 [OR] = 0.179 [95%CI：0.059，0.542]）、固定结构类型（单独使用加压螺钉；OR = 1.789 [95%CI：1.071，2.978]）、缺乏辅助植骨（OR = 2.803 [95%CI：1.081，7.268]）和术后非解剖对线（OR = 3.937 [95%CI：1.278，12.126]）是中跗关节融合术后不愈合的独立预测因素。
本研究比较了 4 种常用固定结构中跗关节融合术后的不愈合率，并探讨了不愈合的危险因素，结果显示糖尿病、单独使用加压螺钉固定、缺乏辅助植骨和术后非解剖对线是中跗关节融合术后不愈合的独立预测因素。
III 级：比较队列研究。
