Fellow, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, CA.
Research Director and Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Podiatric Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA.
J Foot Ankle Surg. 2022 Jan-Feb;61(1):32-36. doi: 10.1053/j.jfas.2021.06.002. Epub 2021 Jun 18.
Multiple fixation techniques for first metatarsophalangeal joint arthrodesis have been described with an average fusion rate of 93.5%. This retrospective cohort study assesses the association between crossed screws (vs dorsal plating) and medical comorbidities and the outcome radiographic union. Bivariate tests of association and multivariable logistic regression were employed to assess differences across fixation type and outcomes. We identified 305 patients who underwent a first metatarsophalangeal joint arthrodesis during the study period. Crossed screw fixation was used in 158 (51.8%) patients while dorsal plating (tubular or anatomic locking plate) was used in 147 (48.2%) patients. Dorsal plating was utilized more often in patients with rheumatoid arthritis (p = .019) and history of smoking (p = .044). At 12 weeks post-operatively there were no significant differences in fusion rates between the two groups (crossed screw group = 95.3% vs dorsal plate group (referent) = 93.5%, Adjusted odds ratio (AOR) 1.39, 95% confidence interval [CI] 0.45-4.26). Not smoking was associated with a greater odds of fusion at 12 weeks (96.2% for nonsmokers vs 75.0% for smokers (referent), AOR 0.07, 95% CI 0.02-0.28). Lower body mass index was associated with a greater odds of fusion at 12 weeks (AOR 0.90, 95% CI 0.82-0.99). Surgeons allowed weightbearing earlier with dorsal plate fixation (2 weeks (interquartile range [IQR] 2.6) versus 5 weeks (IQR 2.6) for crossed screw fixation, p = .001). Patients with multiple medical comorbidities were more likely to require revision surgery than patients having 0-1 comorbidities (p < .05). Crossed screws can provide an inexpensive yet effective option for first metatarsophalangeal joint arthrodesis.
多种第一跖趾关节融合术的固定技术已有报道，平均融合率为 93.5%。本回顾性队列研究评估了交叉螺钉（与背侧钢板）与合并症之间的关系，以及影像学融合的结果。采用双变量关联检验和多变量逻辑回归评估固定类型和结果之间的差异。我们确定了在研究期间接受第一跖趾关节融合术的 305 名患者。交叉螺钉固定用于 158 名（51.8%）患者，而背侧钢板（管状或解剖锁定钢板）固定用于 147 名（48.2%）患者。背侧钢板在类风湿关节炎（p=0.019）和吸烟史（p=0.044）患者中更常用。术后 12 周时，两组融合率无显著差异（交叉螺钉组 95.3%与背侧钢板组（参照）93.5%，调整后的比值比（AOR）1.39，95%置信区间[CI]0.45-4.26）。不吸烟与 12 周时融合的可能性更大相关（非吸烟者为 96.2%，吸烟者为 75.0%（参照），AOR 0.07，95%CI 0.02-0.28）。较低的体重指数与 12 周时融合的可能性更大相关（AOR 0.90，95%CI 0.82-0.99）。背侧钢板固定允许更早负重（2 周（IQR 2.6）与 5 周（IQR 2.6），p=0.001）。与仅有 0-1 种合并症的患者相比，有多种合并症的患者更有可能需要接受翻修手术（p<.05）。交叉螺钉可为第一跖趾关节融合术提供一种经济有效的选择。
