Riegger Martin, Habib Nermine, Testa Enrique Adrian, Müller Jochen, Guidi Marco, Candrian Christian
Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
EFORT Open Rev. 2023 Apr 25;8(4):162-174. doi: 10.1530/EOR-22-0069.
The biomechanical characteristics of different techniques to perform the modified Lapidus procedure are controversial, discussing the issue of stability, rigidity, and compression forces from a biomechanical point of view. The aim of this systematic review was to investigate the available options to identify whether there is a procedure providing superior biomechanical results.
A comprehensive literature search was performed by screening PubMed, Embase, and Cochrane databases until September 2021. There was a wide heterogeneity of the available data in the different studies. Load to failure, stiffness, and compression forces were summarized and evaluated.
Seventeen biomechanical studies were retrieved - ten cadaveric and seven polyurethane foam (artificial bone) studies. Fixation methods ranged from the classic crossed screw approach (n = 5) to plates (dorsomedial and plantar) with or without compression screws (n = 11). Newer implants such as intramedullary stabilization screws (n = 1) and memory alloy staples (n = 2) were investigated.
The two crossed screws construct is still a biomechanical option; however, according to this systematic review, there is strong evidence that a plate-screw construct provides superior stability especially in combination with a compression screw. There is also evidence about plate position and low evidence about compression screw position. Plantar plates seem to be advantageous from a biomechanical point of view, whereas compression screws could be better when positioned outside the plate. Overall, this review suggests the biomechanical advantages of using a combination of locking plates with a compression screw.
不同技术进行改良Lapidus手术的生物力学特性存在争议，从生物力学角度探讨稳定性、刚性和压缩力问题。本系统评价的目的是研究现有选项，以确定是否存在能提供更优生物力学结果的手术方法。
通过筛选PubMed、Embase和Cochrane数据库进行全面文献检索，直至2021年9月。不同研究中的现有数据存在广泛异质性。总结并评估了破坏载荷、刚度和压缩力。
检索到17项生物力学研究——10项尸体研究和7项聚氨酯泡沫（人工骨）研究。固定方法从经典的交叉螺钉入路（n = 5）到带或不带加压螺钉的钢板（背内侧和足底）（n = 11）。还研究了新型植入物，如髓内稳定螺钉（n = 1）和记忆合金钉（n = 2）。
双交叉螺钉结构仍是一种生物力学选择；然而，根据本系统评价，有强有力的证据表明，钢板螺钉结构能提供更优的稳定性，尤其是与加压螺钉联合使用时。也有关于钢板位置的证据，而关于加压螺钉位置的证据较少。从生物力学角度看，足底钢板似乎更具优势，而加压螺钉置于钢板外侧时可能更好。总体而言，本评价表明使用锁定钢板与加压螺钉联合的生物力学优势。
