Balu Abhinav R, Baumann Anthony N, Tsang Terence, Talaski Grayson M, Anastasio Albert T, Walley Kempland C, Adams Samuel B
Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA.
College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA.
Materials (Basel). 2023 Oct 5;16(19):6562. doi: 10.3390/ma16196562.
The first metatarsophalangeal (MTP) joint is a frequently loaded joint, handling loads up to 90% of bodyweight. First MTP arthrodesis is a frequently performed procedure designed to improve pain in patients with degenerative MTP joint disease. There are a wide variety of fixation constructs for this procedure without consensus on the most effective method. The purpose of this study was to compare the biomechanical integrity of various constructs utilized for first MTP arthrodesis. A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, MEDLINE, and Web of Science databases were searched from inception to 18 June 2023. Articles discussing the biomechanics of first MTP arthrodesis constructs were included. A total of 168 articles were retrieved. A total of 20 articles involving 446 cadaveric and synthetic bone constructs were included in the final review. Of the six articles comparing dorsal plating with compression screws to crossed interfragmentary screws, five found that dorsal plating had significantly higher stiffness. All three studies assessing shape-memory staples found them to be significantly less stable than crossed screws or dorsal plates alone. Both studies evaluating fully threaded screws found them to be stronger than crossed cancellous screws. Wedge resections have been shown to be 10 times stronger than standard planar or conical excision. Dorsal plating with compression screws is the gold standard for MTP arthrodesis. However, more research into newer methods such as fully threaded screws and wedge resections with an increased focus on translation to clinical outcomes is needed.
第一跖趾关节是一个承受频繁负荷的关节，能承受高达体重90%的负荷。第一跖趾关节融合术是一种经常施行的手术，旨在改善退行性跖趾关节疾病患者的疼痛。该手术有各种各样的固定结构，对于最有效的方法尚无共识。本研究的目的是比较用于第一跖趾关节融合术的各种结构的生物力学完整性。按照系统评价和Meta分析的首选报告项目（PRISMA）指南对文献进行了系统评价。检索了PubMed、CINAHL、MEDLINE和Web of Science数据库，检索时间从建库至2023年6月18日。纳入讨论第一跖趾关节融合术结构生物力学的文章。共检索到168篇文章。最终综述纳入了20篇涉及446个尸体和合成骨结构的文章。在比较背侧接骨板与加压螺钉和交叉骨折间螺钉的6篇文章中，有5篇发现背侧接骨板的刚度明显更高。所有3项评估形状记忆钉的研究均发现，其稳定性明显低于交叉螺钉或单独的背侧接骨板。两项评估全螺纹螺钉的研究均发现，其比交叉的松质骨螺钉更坚固。楔形切除术已被证明比标准的平面或锥形切除术坚固10倍。背侧接骨板加加压螺钉是跖趾关节融合术的金标准。然而，需要对全螺纹螺钉和楔形切除术等新方法进行更多研究，并更加关注向临床结果的转化。
