第一跖趾关节融合术不愈合相关因素的多中心回顾性队列研究。
Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study.
机构信息
Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany.
出版信息
Foot Ankle Int. 2023 Jun;44(6):508-515. doi: 10.1177/10711007231160754. Epub 2023 Mar 23.
BACKGROUND
Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion.
METHODS
A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion.
RESULTS
Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index.
CONCLUSION
Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery.
LEVEL OF EVIDENCE
Level III, retrospective case control study.
背景
第一跖趾关节融合术是治疗有症状的晚期拇僵硬和中重度拇外翻的首选方法。有不同的方法来进行关节融合术，但对于最佳方法尚无共识。因此，本研究旨在确定术前和术后拇外翻角（HVA）、关节准备和固定技术以及术后固定对不愈合发生率的影响。
方法
进行了一项回顾性多中心队列研究，共纳入 794 例患者。采用单因素和多因素逻辑回归分析确定关节准备、固定技术、术后固定、负重、术前和术后 HVA 与不愈合之间的关系。
结果
不愈合发生率为 15.2%，其中 11.1%为有症状和翻修。与平面切口相比，使用手动器械（OR 3.75，95%CI 1.90-7.42）和凸/凹扩孔器（OR 2.80，95%CI 1.52-5.16）进行关节准备与更高的不愈合几率相关。交叉螺钉固定与更高的不愈合几率相关（OR 2.00，95%CI 1.11-3.42），术前 HVA 更大也是如此（OR 1.02，95%CI 1.00-1.03）。然而，在将术后 HVA 纳入模型后，后者的影响消失，残余术后 HVA 与不愈合之间存在小关联（OR 1.04，95%CI 1.01-1.08）。同样，我们发现不愈合几率与更高的体重（OR 1.02，95%CI 1.01-1.04）有关，但与体重指数无关。
结论
根据我们的结果，第一跖趾关节融合术采用平面切口和钢板及断端螺钉固定与不愈合发生率最低相关。较高的体重和更大的术前 HVA 与不愈合率略有增加相关。在手术中正确矫正拇外翻畸形至关重要。
证据等级
III 级，回顾性病例对照研究。
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