Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada.
Department of Orthopaedics and Traumatology, Cantonal Hospital of Winterthur, Winterthur, Switzerland.
Foot Ankle Int. 2023 Jul;44(7):665-674. doi: 10.1177/10711007231171087. Epub 2023 May 25.
Ankle, hindfoot, and midfoot arthrodesis surgeries are standard procedures performed in orthopaedics to treat pain and functional disabilities. Although fusions can effectively improve pain and quality of life, nonunions remain a significant concern for surgeons. With the increased availability of computed tomography (CT), more surgeons rely on this modality for increased accuracy in determining whether a fusion was successful. The objective of this study was to report the rates of CT-confirmed fusion following ankle, hindfoot, or midfoot arthrodesis.
A systematic review was performed using EMBASE, Medline, and Cochrane central register from January 2000 to March 2020. Inclusion criteria included studies with adults (<18 years) that received 1 or multiple fusions of the ankle, hindfoot, or midfoot. At least 75% of the study cohort must have been evaluated by CT postoperatively. Basic information was collected, including journal, author, year published, and level of evidence. Other specific information was collected, including patient risk factors, fusion site, surgical technique and fixation, adjuncts, union rates, criteria for successful fusion (%), and time of CT. Once data were collected, a descriptive and comparative analysis was performed.
Included studies (26, n = 1300) had an overall CT-confirmed fusion rate of 78.7% (69.6-87.7). Individual joints had an overall fusion rate of 83.0% (73-92.9). The highest rate of union was in the talonavicular joint (TNJ).
These values are lower than previous studies, which found the same procedures to have greater than 90% fusion rates. With these updated figures, as confirmed by CT, surgeons will have better information for clinical decision making and when having informed consent conversations.
踝关节、后足和中足融合术是矫形外科中治疗疼痛和功能障碍的标准手术。虽然融合可以有效地改善疼痛和生活质量，但不愈合仍然是外科医生关注的重要问题。随着计算机断层扫描（CT）的广泛应用，越来越多的外科医生依赖这种方法来提高确定融合是否成功的准确性。本研究的目的是报告踝关节、后足或中足融合术后 CT 确认融合的发生率。
采用 EMBASE、Medline 和 Cochrane 中心注册数据库，对 2000 年 1 月至 2020 年 3 月的文献进行系统评价。纳入标准包括接受 1 次或多次踝关节、后足或中足融合的成人（<18 岁）研究。至少有 75%的研究队列必须在术后通过 CT 进行评估。收集的基本信息包括期刊、作者、发表年份和证据水平。还收集了其他具体信息，包括患者的风险因素、融合部位、手术技术和固定、辅助手段、融合率、成功融合的标准（%）和 CT 时间。一旦收集了数据，就进行了描述性和对比分析。
纳入的研究（26 项研究，n=1300）的 CT 确认融合率总体为 78.7%（69.6%-87.7%）。各个关节的融合率总体为 83.0%（73%-92.9%）。最高的融合率见于距跟舟关节（TNJ）。
这些数值低于之前的研究，之前的研究发现相同的手术有超过 90%的融合率。有了这些经过 CT 确认的更新数据，外科医生将在临床决策和获得知情同意谈话时拥有更好的信息。
