Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Foshan, Guangdong, China.
Foot Ankle Int. 2024 Mar;45(3):225-235. doi: 10.1177/10711007231220911. Epub 2024 Feb 22.
Midfoot arthrodesis is regarded as the main surgical approach for treating Müller-Weiss disease (MWD). This study aimed to investigate the incidence of postoperative pain during MWD treatment through midfoot reduction or malreduction during arthrodesis and to explore the factors influencing postoperative pain in patients with MWD.
A total of 67 patients with MWD were recruited and divided into two groups according to whether midfoot alignment was reduced: reduction group ( = 38) and malreduction group ( = 29). Demographic characteristics before the operation and at the last follow-up, as well as clinical and radiographic parameters, were compared between the two groups. Clinical parameters included the American Orthopaedic Foot & Ankle Society score and visual analog scale score, whereas radiographic parameters included the calcaneal pitch angle, lateral Meary's angle, talometatarsal-1 angle dorsoplantar (TMT1dp), talocalcaneal angle dorsoplantar (Kite angle), talonavicular coverage angle, and medial navicular pole extrusion. Postoperative complications and incidence of midfoot pain were evaluated at the last follow-up visit.
The reduction group exhibited better clinical and radiological parameters, including the TMT1dp and medial navicular pole extrusion, than the malreduction group at the last follow-up (all < .05). However, the calcaneal pitch angle, lateral Meary's angle, Kite angle, and talonavicular coverage angle did not significantly differ between the two groups (all > .05). The overall incidence of midfoot pain was 26.4%. The reduction group showed a lower incidence of medial pain than the malreduction group (15.7% vs. 40.0%, < .05). Regression analysis revealed that midfoot abduction, represented by the TMT1dp, was a critical factor for midfoot arthrodesis failure and that medial navicular pole extrusion was not correlated with postoperative midfoot pain.
Midfoot reduction arthrodesis yields better clinical outcomes than malreduction arthrodesis. The TMT1dp, representing midfoot abduction, is a key factor for midfoot arthrodesis failure. The extruded medial navicular bone may not affect postoperative medial midfoot pain.
Level III, retrospective comparative study.
中跗关节融合术被认为是治疗 Müller-Weiss 病（MWD）的主要手术方法。本研究旨在探讨在 MWD 治疗过程中通过跗骨中部复位或复位不良进行中跗关节融合术时术后疼痛的发生率，并探讨影响 MWD 患者术后疼痛的因素。
共纳入 67 例 MWD 患者，根据中跗对线是否降低分为两组：复位组（n=38）和复位不良组（n=29）。比较两组患者术前和末次随访时的一般资料和临床、影像学参数。临床参数包括美国矫形足踝协会评分和视觉模拟评分，影像学参数包括跟骨倾斜角、外侧 Meary 角、距跟-1 角背跖（TMT1dp）、跟距角背跖（Kite 角）、距舟覆盖角和内侧舟骨突挤出。末次随访时评估术后并发症和中跗疼痛发生率。
末次随访时，复位组 TMT1dp 和内侧舟骨突挤出等临床和影像学参数优于复位不良组（均 P<.05）。而两组跟骨倾斜角、外侧 Meary 角、Kite 角和距舟覆盖角差异均无统计学意义（均 P>.05）。中跗疼痛总发生率为 26.4%。复位组内侧疼痛发生率低于复位不良组（15.7%比 40.0%，P<.05）。回归分析显示，以 TMT1dp 为代表的中跗外展是中跗融合失败的关键因素，而内侧舟骨突挤出与术后中跗疼痛无关。
中跗复位融合术的临床效果优于复位不良融合术。以 TMT1dp 为代表的中跗外展是中跗融合失败的关键因素。内侧舟骨突挤出可能不会影响术后内侧中跗疼痛。
III 级，回顾性比较研究。
