Agrawal Somen, Sridhar Sumedh, Harrison Matt, Houchen-Wolloff Linzy, Divall Pip, Mangwani Jitendra
Department of Orthopaedic Surgery University Hospital Coventry and Warwickshire, Clifford Bridge Rd, Coventry, CV2 2DX, United Kingdom.
Leicester Medical School, University Road, Leicester, LE1 7RH, United Kingdom.
J Orthop. 2024 Jun 24;58:29-34. doi: 10.1016/j.jor.2024.06.030. eCollection 2024 Dec.
The pre-existing co-morbidities have a major impact on the outcomes of Orthopaedic procedures as shown by the several studied in various contexts. However, the specific influence of these co-morbidities on first metatarsophalangeal joint fusion remains relatively underexplored. This study aims to address this gap by examining the association between co-morbidities such as obesity, smoking, diabetes, advancing age, and rheumatoid arthritis, and the outcomes of first metatarsophalangeal joint fusion.
A comprehensive search was conducted across multiple databases, including MEDLINE, EMBASE, and CINAHL. Relevant articles were identified and processed using Covidence, with independent assessment conducted to ensure inclusion criteria were met. The focus of the review was on analysing the effects of specific co-morbidities on fusion outcomes.
Seven qualifying studies were identified for full-text extraction, revealing significant heterogeneity across the literature, which hindered direct statistical comparisons. The findings presented inconclusive effects of obesity on fusion outcomes, with ambiguous impacts observed for diabetes mellitus and smoking. Additionally, no discernible variance was observed in functional outcomes across different age groups. Furthermore, steroid usage in rheumatoid arthritis cases demonstrated delayed fusion in revision procedures, while primary outcomes remained uncertain.
This systematic review highlights the need for further research with standardised methodologies to better understand the correlation between pre-existing co-morbidities and outcomes in first metatarsophalangeal joint fusion. By elucidating these relationships, clinicians can better tailor treatment approaches and optimise patient care in this specific Orthopaedic context.
Level III.
如在各种背景下的多项研究所表明的那样，既往并存疾病对骨科手术的结果有重大影响。然而，这些并存疾病对第一跖趾关节融合的具体影响仍相对未被充分探索。本研究旨在通过检查肥胖、吸烟、糖尿病、高龄和类风湿关节炎等并存疾病与第一跖趾关节融合结果之间的关联来填补这一空白。
在多个数据库中进行了全面检索，包括MEDLINE、EMBASE和CINAHL。使用Covidence识别并处理相关文章，并进行独立评估以确保符合纳入标准。综述的重点是分析特定并存疾病对融合结果的影响。
确定了七项符合条件的研究进行全文提取，结果显示文献中存在显著异质性，这阻碍了直接的统计比较。研究结果表明肥胖对融合结果的影响尚无定论，糖尿病和吸烟的影响也不明确。此外，不同年龄组的功能结果未观察到明显差异。此外，类风湿关节炎病例中使用类固醇在翻修手术中显示融合延迟，而主要结果仍不确定。
本系统综述强调需要采用标准化方法进行进一步研究，以更好地了解既往并存疾病与第一跖趾关节融合结果之间的相关性。通过阐明这些关系，临床医生可以在这种特定的骨科情况下更好地调整治疗方法并优化患者护理。
三级。
