评估踝关节和后足关节融合术后患者报告的预期疼痛和功能结果。
Evaluating Prospective Patient-Reported Pain and Function Outcomes After Ankle and Hindfoot Arthrodesis.
作者信息
Mehta Manish P, Mehta Mitesh P, Sherman Alain E, Mutawakkil Muhammad Y, Bell Raheem, Patel Milap S, Kadakia Anish R
机构信息
Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
出版信息
Foot Ankle Orthop. 2021 Oct 29;6(4):24730114211040740. doi: 10.1177/24730114211040740. eCollection 2021 Oct.
BACKGROUND
Hindfoot and ankle fusions are mechanically limiting procedures for patients. However, patient-reported outcomes of these procedures have not been well studied. This study assessed outcomes of hindfoot and ankle fusions by using Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs).
METHODS
Between 2014 and 2018, 102 patients were prospectively enrolled after presenting to a tertiary care facility for ankle and hindfoot fusions, including tibiotalar, tibiotalocalcaneal, subtalar, and triple arthrodeses. Study participants completed preoperative and 12-month postoperative PF and PI CATs. The differences between mean 12-month postoperative and preoperative PROMIS PF and PI scores were analyzed with paired tests. The relationship between the 12-month PF and PI differences for the overall sample and patient factors was examined using multiple regression modeling.
RESULTS
The sample had mean age of 57.69 years; 48% were male, and 55% were obese. Patients who underwent ankle and hindfoot arthrodesis had statistically significant improvements from preoperative to 12 months postoperative in mean PF (36.26±7.85 vs 39.38±6.46, = .03) and PI (61.07±7.75 vs 56.62±9.81, = .02). Triple arthrodesis saw the greatest increases in physical function (▵PF = 7.22±7.31, = .01) and reductions in pain (▵PI = -9.17±8.31, = .01), achieving minimal clinically important difference (MCID). Patients who underwent tibiotalar fusion had significant improvement in physical function (▵PF = 4.18±5.68, = .04) and pain reduction that approached statistical significance (▵PI = -6.24±8.50, = .09), achieving MCID. Older age (≥60 years ) was associated with greater improvements in PF ( = 0.20, = .07) and PI ( = -0.29, = .04). Preoperative PF and PI scores were significantly associated with the 12-month change in PF and PI scores, respectively ( = -0.74, < .01; = -0.61, < .01).
CONCLUSION
Hindfoot and ankle fusions are procedures with favorable patient outcomes leading to increased physical function and decreased pain at 12 months postoperation relative to preoperation.
LEVEL OF EVIDENCE
Level II, prospective comparative study.
背景
后足和踝关节融合术对患者来说是机械性受限的手术。然而，这些手术的患者报告结局尚未得到充分研究。本研究通过使用患者报告结局测量信息系统（PROMIS）身体功能（PF）和疼痛干扰（PI）计算机自适应测试（CATs）来评估后足和踝关节融合术的结局。
方法
2014年至2018年期间，102例患者在三级医疗中心接受踝关节和后足融合术（包括胫距、胫距跟、距下和三关节融合术）后被前瞻性纳入研究。研究参与者完成了术前和术后12个月的PF和PI CATs测试。采用配对t检验分析术后12个月与术前PROMIS PF和PI评分的差异。使用多元回归模型检验总体样本的12个月PF和PI差异与患者因素之间的关系。
结果
样本的平均年龄为57.69岁；48%为男性，55%为肥胖患者。接受踝关节和后足融合术的患者从术前到术后12个月，平均PF（36.26±7.85对39.38±6.46，P = .03）和PI（61.07±7.75对56.62±9.81，P = .02）有统计学显著改善。三关节融合术的身体功能改善最大（△PF = 7.22±7.31，P = .01），疼痛减轻（△PI = -9.17±8.31，P = .01），达到最小临床重要差异（MCID）。接受胫距融合术的患者身体功能有显著改善（△PF = 4.18±5.68，P = .04），疼痛减轻接近统计学显著水平（△PI = -6.24±8.50，P = .09），达到MCID。年龄较大（≥60岁）与PF（β = 0.20，P = .07）和PI（β = -0.29，P = .04）的更大改善相关。术前PF和PI评分分别与术后12个月PF和PI评分的变化显著相关（β = -0.74，P < .01；β = -0.61，P < .01）。
结论
后足和踝关节融合术的患者结局良好，与术前相比，术后12个月身体功能增强，疼痛减轻。
证据水平
II级，前瞻性比较研究。
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