Residency Director and Attending Staff, Department of Orthopedics, Kaiser San Francisco Bay Area Foot and Ankle Residency Program Kaiser Foundation Hospital, Oakland, CA.
Foot and Ankle Surgeon, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, CA.
J Foot Ankle Surg. 2022 Sep-Oct;61(5):979-985. doi: 10.1053/j.jfas.2021.12.024. Epub 2021 Dec 20.
The Lapidus arthrodesis is a powerful procedure for the correction of hallux valgus with metatarsus primus varus. Yet, first ray instability may persist despite correction of the primary deformity with 2 crossed screw fixation. A third screw is often utilized as the additional point of fixation for noteworthy residual transverse plane motion, but it is not without potential complications. The suture and button fixation device may be an appropriate alternative to the third screw construct. This retrospective cohort study identified clinical / radiographic outcomes and complication rates following a third point of fixation with either a screw or suture and button fixation device in patients undergoing a modified Lapidus arthrodesis. One surgeon performed all of the Lapidus procedure with a third screw while the other surgeon performed all with a suture and button fixation device. Of 136 consecutive patients who underwent a modified Lapidus arthrodesis, 83 (61%) patients required a third point of fixation for satisfactory stabilization of the first ray. Surgical technique was similar between the 2 surgeons; however, one utilized the suture and button fixation device method (n = 36), while the other used a third screw for fixation (n = 47). Many of the clinical outcomes, radiographic results, and the union rate were similar between the 2 methods. Nineteen (40%) complications occurred in the third screw group compared to 6 (17%) in the suture and button fixation device group. However, the third screw group demonstrated 100% maintenance of deformity correction at 1 year versus 95% in the suture and button fixation device group. Although fixation with a suture and button fixation device was associated with fewer complications, a larger study is necessary to determine if these variations are statistically significant.
Lapidus 关节融合术是一种强大的方法，可用于矫正拇外翻伴第一跖骨内翻。然而，尽管通过 2 枚交叉螺钉固定矫正了主要畸形，但第一跖骨仍可能不稳定。通常会使用第三枚螺钉作为固定的附加点，以解决显著的横向平面运动，但这并非没有潜在的并发症。缝线和纽扣固定装置可能是第三枚螺钉结构的合适替代方法。本回顾性队列研究确定了在接受改良 Lapidus 关节融合术的患者中，通过第三枚螺钉或缝线和纽扣固定装置进行第三点固定后，临床/影像学结果和并发症发生率。一位外科医生对所有患者均使用第三枚螺钉进行 Lapidus 手术，而另一位外科医生则均使用缝线和纽扣固定装置。在 136 例连续接受改良 Lapidus 关节融合术的患者中，83 例（61%）患者需要第三点固定，以确保第一跖骨稳定。两位外科医生的手术技术相似；然而，一位使用缝线和纽扣固定装置（n=36），另一位则使用第三枚螺钉固定（n=47）。两种方法的许多临床结果、影像学结果和融合率均相似。第三枚螺钉组有 19 例（40%）并发症，缝线和纽扣固定装置组有 6 例（17%）。然而，第三枚螺钉组在 1 年时保持 100%的畸形矫正，而缝线和纽扣固定装置组为 95%。尽管使用缝线和纽扣固定装置固定与并发症较少相关，但需要更大的研究来确定这些差异是否具有统计学意义。
