Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, China.
Orthop Surg. 2024 Oct;16(10):2562-2568. doi: 10.1111/os.14205. Epub 2024 Aug 27.
Arthrodesis, usage of metallic implants for internal fixation, is commonly employed as the primary treatment modality for Müller-Weiss disease (MWD). Nevertheless, the efficacy of the current methods of fixation leaves room for improvement. Inadequate fixation strength and the risk of fixation failure are both critical concerns requiring attention. This study explored the clinical effects of implementing a modified fixation technique in talonavicular arthrodesis for the treatment of MWD.
A total of 14 cases diagnosed with MWD undergoing talonavicular (TN) arthrodesis from January 2021 toMarch 2023 were included in the retrospective study. The fixation method for fusion involved the use of screws, with additional support from the shape-memory alloy (SMA) staple. Relevant clinical outcomes and complications were evaluated preoperatively and postoperatively. Paired-samples t-test was used for all data comparisons.
Radiographic evidence confirmed solid fusion, and follow-up evaluations showed satisfactory results in all cases. The American Orthopedic Foot and Ankle Society (AOFAS) scores were elevated from 32.21 ± 4.0 (range: 22-38) preoperatively to 86.5 ± 2.7 (range: 81-90) postoperatively (p < 0.001). The visual analog scale (VAS) scores declined from 7.40 ± 0.8 (range: 6-8.5) preoperatively to 1.21 ± 1.1 (range: 0-3) postoperatively (p < 0.001). The lateral Meary's angle changed from 13.50 ± 5.2 (range: 8-24) preoperatively to 4.14 ± 2.9 (range: 1-11) degrees postoperatively (p < 0.001). The calcaneal pitch angle increased from 10.07 ± 4.0 (range: 5-19) preoperatively to 14.35 ± 4.0 (range: 8-21) degrees postoperatively (p < 0.001). The talar-first metatarsal angle decreased from 11.71 ± 3.8 (range: 8-18) preoperatively to 4.28 ± 3.1 (range: 0-9) degrees postoperatively (p < 0.001). One patient was observed to experience delayed wound healing and wound infection. No nerve damage, malunion, pseudoarthrosis, or fixation failure were observed.
The results indicated that the fusion of the TN joint using a combination of screws and shape memory alloy staples, could lead to favorable clinical outcomes and significantly enhance the quality of life for patients with MWD. This technique is not only safe and effective but also straightforward to perform.
关节融合术，即使用金属植入物进行内固定，通常是 Müller-Weiss 病（MWD）的主要治疗方式。然而，目前固定方法的疗效还有待提高。固定强度不足和固定失败的风险都是需要关注的关键问题。本研究探讨了在治疗 MWD 时采用改良固定技术进行距舟关节融合术的临床效果。
回顾性研究纳入了 2021 年 1 月至 2023 年 3 月期间接受距舟关节（TN）融合术治疗的 14 例 MWD 患者。融合时采用螺钉固定，并辅以形状记忆合金（SMA）钉的支撑。对术前和术后的相关临床结果和并发症进行评估。所有数据比较均采用配对样本 t 检验。
影像学证实融合牢固，所有患者随访结果均满意。美国矫形足踝协会（AOFAS）评分从术前的 32.21±4.0（范围：22-38）提高到术后的 86.5±2.7（范围：81-90）（p<0.001）。视觉模拟评分（VAS）从术前的 7.40±0.8（范围：6-8.5）降至术后的 1.21±1.1（范围：0-3）（p<0.001）。外侧 Meary 角从术前的 13.50±5.2（范围：8-24）变为术后的 4.14±2.9（范围：1-11）度（p<0.001）。跟骨倾斜角从术前的 10.07±4.0（范围：5-19）增加到术后的 14.35±4.0（范围：8-21）度（p<0.001）。距骨第一跖骨角从术前的 11.71±3.8（范围：8-18）变为术后的 4.28±3.1（范围：0-9）度（p<0.001）。1 例患者出现伤口愈合延迟和感染。未观察到神经损伤、畸形愈合、假关节或固定失败。
结果表明，使用螺钉和形状记忆合金钉联合固定距舟关节可获得良好的临床效果，显著提高 MWD 患者的生活质量。该技术不仅安全有效，而且操作简单。
