Filomeno Paola, López Julio
Instituto Nacional de Otropedia y Traumatología (INOT), Universidad de la Republica del Uruguay, Montevideo, Uruguay.
Mutualista Médica Uruguaya (MUCAM), Montevideo, Uruguay.
Foot Ankle Orthop. 2023 Aug 6;8(3):24730114231193424. doi: 10.1177/24730114231193424. eCollection 2023 Jul.
First metatarsophalangeal (MTP) joint arthrodesis can be fixed using either a dorsal plate or crossed screws. However, there is considerable difference in the cost of these implants, and it is not known if there is sufficient difference in outcome that might justify this cost difference. Our aim was to compare the functional results and patient satisfaction rates after first MTP joint arthrodesis in a group of patients using the same surgical technique except for the fixation devices.
A prospective cohort of 27 patients who underwent first MTP joint fusion by the same surgeon using 2 crossed screws or a single screw with a dorsal plate was recruited over a 3-year period. Demographic information, patient satisfaction rates, complications, and union rates were evaluated. American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scoring systems were used pre- and postoperatively to compare the functional outcomes. Thirty consecutive procedures (screws, n = 15; plate, n = 15) were performed. Age (55.8 ± 11.1 vs 63.3 ± 12.4 years for screws and plate respectively; = .091) and female gender percentages (80% and 73%, = .666) were similar between groups.
The overall union rate was 93% with no differences between groups. AOFAS and VAS scores improved significantly postoperatively for each technique, and no differences were found between the two in the improvement in AOFAS (42.4 ± 8.0 vs 44.3 ± 8.2, screws and plate respectively; = .520) and VAS scores (66.0 ± 5.4 vs 69.0 ± 6.9; = .195). The implant cost for screws was $40 and for dorsal plate, $328.
First MTP joint fusion using either screws or plate fixation results in an improvement in AOFAS and VAS scores. Functional improvement and patient satisfaction did not differ between the 2 techniques, despite a considerable difference in cost between the two methods of fixation.
Level III, prospective comparative study.
第一跖趾关节（MTP）融合术可使用背侧钢板或交叉螺钉进行固定。然而，这些植入物的成本存在显著差异，且尚不清楚在疗效上是否存在足以证明这种成本差异合理的显著差异。我们的目的是比较一组患者在使用相同手术技术（除固定装置外）进行第一跖趾关节融合术后的功能结果和患者满意度。
在3年时间里招募了27例由同一位外科医生采用2枚交叉螺钉或1枚螺钉加背侧钢板进行第一跖趾关节融合术的患者组成的前瞻性队列。评估了人口统计学信息、患者满意度、并发症和骨愈合率。术前和术后使用美国矫形足踝协会（AOFAS）和视觉模拟评分（VAS）系统比较功能结果。连续进行了30例手术（螺钉组，n = 15；钢板组，n = 15）。两组之间的年龄（螺钉组和钢板组分别为55.8±11.1岁和63.3±12.4岁；P = 0.091）和女性比例（80%和73%，P = 0.666）相似。
总体骨愈合率为93%，两组之间无差异。每种技术术后AOFAS和VAS评分均显著改善，两种技术在AOFAS评分改善方面（螺钉组和钢板组分别为42.4±8.0和44.3±8.2；P = 0.520）以及VAS评分改善方面（66.0±5.4和69.0±6.9；P = 0.195）均未发现差异。螺钉的植入成本为40美元，背侧钢板为328美元。
使用螺钉或钢板固定进行第一跖趾关节融合术均可使AOFAS和VAS评分得到改善。尽管两种固定方法在成本上存在显著差异，但两种技术在功能改善和患者满意度方面并无差异。
III级，前瞻性比较研究。
