既往拇趾关节切除术对治疗僵硬性拇趾第一跖趾关节融合术结局的影响。
Effect of Prior Cheilectomy on Outcomes of First Metatarsophalangeal Joint Fusion for Treatment of Hallux Rigidus.
作者信息
Rajan Lavan, Kim Jaeyoung, An Tonya, Mizher Rami, Srikumar Syian, Fuller Robert, Zhu Jiaqi, Ellis Scott J
机构信息
Hospital for Special Surgery, New York, NY, USA.
New York Medical College, Valhalla, NY, USA.
出版信息
Foot Ankle Orthop. 2022 Aug 23;7(3):24730114221119740. doi: 10.1177/24730114221119740. eCollection 2022 Jul.
BACKGROUND
Patients with hallux rigidus who do not experience significant pain relief after cheilectomy often require a conversion to metatarsophalangeal (MTP) fusion. However, it is unclear whether the previous cheilectomy affects outcomes of the subsequent fusion. The aim of this study was to compare patient-reported outcomes and complications in patients undergoing MTP fusion for hallux rigidus between patients with a history of cheilectomy and those undergoing a fusion as a primary procedure.
METHODS
This retrospective cohort study included patients who underwent MTP fusion who had preoperative and minimum 1-year postoperative Patient Reported Outcomes Measurement Information System (PROMIS) scores. Patients were divided into a "primary MTP fusion" cohort and a "prior cheilectomy" cohort based on their history of a previous cheilectomy. Preoperative, postoperative, and improvement in PROMIS scores, along with rates of complications including nonunion, infection, interphalangeal (IP) joint pain, and removal of hardware were compared between groups.
RESULTS
The prior cheilectomy group had significantly lower preoperative physical function scores than the primary MTP fusion group ( < .05). Postoperatively, the prior cheilectomy group had worse physical function ( < .017) and global physical health ( < .017) scores. However, there were no significant differences in pre- to postoperative change in PROMIS scores. There were no significant differences in rates of nonunion ( = .99), infection ( = .99), or hardware removal ( = .99). More patients in the prior cheilectomy group had IP joint pain ( = .034).
CONCLUSION
This study found that a prior cheilectomy may not affect serious complication rates of a subsequent fusion, but it may be associated with worse baseline function. Overall, our results suggest that a prior failed cheilectomy does not influence the amount of improvement in function and pain from MTP fusion.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
背景
拇僵硬患者在进行关节切除术后若未获得显著的疼痛缓解，通常需要转而进行跖趾关节（MTP）融合术。然而，先前的关节切除术是否会影响后续融合术的效果尚不清楚。本研究的目的是比较有关节切除术史的拇僵硬患者与初次接受融合术的患者在接受MTP融合术后的患者报告结局及并发症情况。
方法
这项回顾性队列研究纳入了接受MTP融合术且术前及术后至少1年有患者报告结局测量信息系统（PROMIS）评分的患者。根据患者先前是否有过关节切除术史，将患者分为“初次MTP融合”队列和“先前有过关节切除术”队列。比较两组患者术前、术后及PROMIS评分的改善情况，以及包括骨不连、感染、指间（IP）关节疼痛和内固定取出率在内的并发症发生率。
结果
先前有过关节切除术的组术前身体功能评分显著低于初次MTP融合组（P<0.05）。术后，先前有过关节切除术的组身体功能（P<0.017）和总体身体健康（P<0.017）评分更差。然而，PROMIS评分术前至术后的变化在两组间无显著差异。骨不连发生率（P = 0.99）、感染发生率（P = 0.99）或内固定取出率（P = 0.99）无显著差异。先前有过关节切除术的组中更多患者存在IP关节疼痛（P = 0.034）。
结论
本研究发现先前的关节切除术可能不会影响后续融合术的严重并发症发生率，但可能与更差的基线功能相关。总体而言，我们的结果表明先前失败的关节切除术不会影响MTP融合术后功能和疼痛的改善程度。
证据级别
III级，回顾性队列研究。
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