Haimes Mark A, Roberts Michael S, Bougioukas Lauren, Michelson James D
From the Department of Orthopaedics and Rehabilitation, Larner College of Medicine at the University of Vermont, Burlington, VT.
J Am Acad Orthop Surg. 2023 Nov 1;31(21):e1012-e1020. doi: 10.5435/JAAOS-D-23-00185. Epub 2023 Jun 22.
The ideal fixation method for the first metatarsophalangeal joint (first MTP) remains uncertain. This study compares nonunion and revision surgery rates of first MTP arthrodesis between nonlocking semitubular plates and precontoured locking plates.
Demographics, fixation technique, and complications of all patients who underwent primary first MTP arthrodesis between 2013 and 2018 were determined from radiographs and clinical records. Cost data were from a 1-year subset of isolated first MTP fusion surgeries. The primary outcome measures of this study were the nonunion and complication rates, with associated costs of patients undergoing first metatarsophalangeal arthrodesis with either a noncontoured semitubular plate or a precontoured locking plate.
The study included 189 patients, with a mean follow-up of 18.7 months. The overall nonunion rate was 10.1%, with no difference between the locking and nonlocking plates. The prevalence of a painful implant was also similar. Surgeries using locking plates cost an average of $1,500 more than those using nonlocked plates.
Because there was no difference in revision between locking and nonlocking plate fixation for primary first MTP arthrodesis, routine use of the more expensive locking plates may not be justified.
Level III (Retrospective cohort study).
第一跖趾关节（第一MTP）的理想固定方法仍不明确。本研究比较了非锁定半管状钢板和预塑形锁定钢板在第一MTP关节融合术中的骨不连和翻修手术率。
从X线片和临床记录中确定2013年至2018年间接受初次第一MTP关节融合术的所有患者的人口统计学资料、固定技术和并发症。成本数据来自孤立的第一MTP融合手术的1年子集。本研究的主要结局指标是骨不连和并发症发生率，以及接受非塑形半管状钢板或预塑形锁定钢板进行第一跖趾关节融合术患者的相关成本。
该研究纳入了189例患者，平均随访18.7个月。总体骨不连率为10.1%，锁定钢板和非锁定钢板之间无差异。植入物疼痛的发生率也相似。使用锁定钢板的手术平均比使用非锁定钢板的手术贵1500美元。
由于初次第一MTP关节融合术在锁定钢板和非锁定钢板固定的翻修方面没有差异，常规使用更昂贵的锁定钢板可能不合理。
III级（回顾性队列研究）。
