Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan.
Department of Orthopedics, En Chu Kong Hospital, New Taipei City, Taiwan.
BMC Musculoskelet Disord. 2022 Jul 27;23(1):715. doi: 10.1186/s12891-022-05629-7.
Müller-Weiss disease (MWD), a rare dysplastic disorder of the foot, is characterized by deformity, sclerosis, and fragmentation of the lateral part of navicular bone. Arthrodesis is the mainstay treatment for MWD. Generally, arthrodesis can be achieved through internal fixation with metallic implants, and morselized chip bone may be packed into the gap for better bone union. However, with this procedure, the original foot size is not maintained and support for the foot arch is not provided. Sequela of short foot, or flatfoot is commonly observed even though these complications of surgery had not been reported with cases of MWD treated by arthrodesis. Herein, we present a retrospective analysis of treating MWD through midfoot and hindfoot arthrodesis combined with strut allograft.
From August 2006 to June 2019, 20 patients with MWD (mean age, 59.6 years; range, 40-80 years) underwent midfoot and hindfoot arthrodesis with strut bone allograft and were followed for at least 24 months. The patients were able to ambulate and participate in rehabilitation programs 3 months postoperatively.
The used four radiographic parameters (Meary's angle in anteroposterior and lateral view, talonavicular coverage angle, calcaneal pitch) demonstrated significant differences (P < .05) preoperatively and postoperatively, but those between the postoperative values and the values at the last follow-up session did not, indicating that strut allograft was able to maintain normal alignment. The mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scores at 2 years postoperatively revealed significant improvement from baseline, from 60.2 to 84.2 (P < .05). The 12-item Short Form Health Survey scores also improved significantly (P < .05). All patients reported substantial pain relief and exhibited improved functional outcomes and gait patterns.
For advanced-stage MWD, arthrodesis with a precisely shaped, size-matched strut allograft provided strong support for biomechanical alignment and enhanced functional performance.
Müller-Weiss 病（MWD）是一种罕见的足部发育性疾病，其特征为跗骨外侧部分的畸形、硬化和碎裂。关节融合术是 MWD 的主要治疗方法。通常，关节融合术可以通过金属植入物内固定来实现，并且可以将碎骨片填充到间隙中以促进更好的骨愈合。然而，采用这种方法无法维持足部原有的大小，也无法提供足弓的支撑。尽管没有报道过 MWD 关节融合术后出现这些并发症，但仍常观察到短足或平足等后遗症。在此，我们回顾性分析了采用中后足关节融合术联合支撑同种异体骨治疗 MWD 的病例。
2006 年 8 月至 2019 年 6 月，20 例 MWD 患者（平均年龄 59.6 岁；范围，40-80 岁）接受了中后足关节融合术联合支撑同种异体骨治疗，随访时间至少 24 个月。患者术后 3 个月即可行走并参与康复计划。
使用的 4 项影像学参数（前后位和侧位的 Meary 角、距舟覆盖角、跟骨倾斜角）在术前和术后均有显著差异（P<.05），但术后值与末次随访时的差异无统计学意义，表明支撑同种异体骨能够维持正常的对线。术后 2 年的美国矫形足踝协会踝关节-后足评分平均从基线的 60.2 分显著提高到 84.2 分（P<.05）。12 项简明健康调查问卷评分也有显著改善（P<.05）。所有患者均报告疼痛明显缓解，并表现出功能改善和步态模式的改善。
对于晚期 MWD，采用精确塑形、大小匹配的支撑同种异体骨进行关节融合术为生物力学对线提供了强有力的支撑，并增强了功能表现。
