Loveland Jeffrey D
Central Tennessee Foot and Ankle Center, 415 Sewell Road, Sparta, TN, 38583, USA.
J Orthop. 2023 Sep 9;44:93-98. doi: 10.1016/j.jor.2023.09.005. eCollection 2023 Oct.
Nonunion following foot and ankle arthrodesis can cause chronic pain and disability, poor patient satisfaction, and increased healthcare costs. Nonunion rates are reported in 10%-12% of primary foot and/or ankle arthrodesis procedures, with significantly greater rates among patients with high-risk factors such as smoking, diabetes, obesity, or Charcot neuroarthropathy. Recombinant human platelet-derived growth factor BB-homodimer with beta-tricalcium phosphate (rhPDGF-BB/β-TCP) is a bone graft substitute that has demonstrated efficacy in foot and ankle fusion rates that are comparable to autograft.
Charts and radiographs were retrospectively reviewed on consecutive adult patients undergoing talonavicular, calcaneal-cuboid, subtalar, and/or ankle arthrodesis utilizing rhPDGF-BB/β-TCP bone graft substitute. The primary outcome measures were rate of and mean time to fusion, mean time to return to function, and incidence of adverse events.
This study reviewed133 patients who underwent 209 hindfoot and/or ankle joint arthrodesis procedures with a mean follow-up 20.34 ± 11.05 months. The overall fusion rate was 92.82% (194/209 joints) with a mean time to fusion of 13.14 ± 2.52 weeks and return to function of 16.56 ± 3.26 weeks. Overall, there were 7 (5.26%) patients who experienced an adverse event (AE) with 15 (7.18%) joints experiencing a nonunion.
Fusion rates with rhPDGF-BB/β-TCP bone grafting material compared favorably to autograft controls when used in hindfoot and/or ankle arthrodesis. No AEwas related to rhPDGF-BB/β-TCP. This study suggests that using rhPDGF-BB/β-TCP is effective in hindfoot and/or ankle arthrodesis, even among patients with comorbidities who are at a higher risk of developing a nonunion.
足踝融合术后骨不连可导致慢性疼痛和功能障碍，患者满意度低，并增加医疗成本。据报道，初次足踝融合手术的骨不连发生率为10% - 12%，在有吸烟、糖尿病、肥胖或夏科氏神经关节病等高风险因素的患者中发生率显著更高。重组人血小板衍生生长因子BB - 同二聚体与β - 磷酸三钙（rhPDGF - BB/β - TCP）是一种骨移植替代物，已证明在足踝融合率方面与自体骨相当。
对连续接受距舟、跟骰、距下和/或踝关节融合术并使用rhPDGF - BB/β - TCP骨移植替代物的成年患者的病历和X线片进行回顾性分析。主要观察指标为融合率、平均融合时间、平均恢复功能时间和不良事件发生率。
本研究回顾了133例接受209例后足和/或踝关节融合手术的患者，平均随访20.34 ± 11.05个月。总体融合率为92.82%（194/209个关节），平均融合时间为13.14 ± 2.52周，恢复功能时间为16.56 ± 3.26周。总体而言，有7例（5.26%）患者发生不良事件（AE），15个关节（7.18%）发生骨不连。
在足后和/或踝关节融合术中，rhPDGF - BB/β - TCP骨移植材料的融合率与自体骨对照相比具有优势。未发现不良事件与rhPDGF - BB/β - TCP相关。本研究表明，使用rhPDGF - BB/β - TCP在足后和/或踝关节融合术中是有效的，即使在有骨不连高风险合并症的患者中也是如此。
3级
