Minelli Marco, deMeireles Alirio J, Marciano Gerard F, Chien Bonnie Y, Malempati Mahant, Vulcano Ettore
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
Department of Orthopedic Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, 622 West 168Th Street, PH 11 - 1102, New York, NY, 10032-3720, USA.
Arch Orthop Trauma Surg. 2025 Jan 11;145(1):123. doi: 10.1007/s00402-024-05613-x.
In the case of end-stage hallux rigidus, first metatarsophalangeal (MTP) joint arthrodesis is the gold-standard and is traditionally performed via an open approach. However, complications such as nonunion have been reported to be as high as 30%. Recently, there have been reports demonstrating a percutaneous approach to be effective and safe.
Forty-nine patients with end-stage hallux rigidus underwent percutaneous first MTP joint arthrodesis with calcaneus autograft performed by a single surgeon. Each patient underwent a minimum of 24 month clinical and radiographic follow up, including 3 month post operative computed tomography scans. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Foot Function Index (FFI) preoperatively and at final follow-up.
Mean follow-up was 27.3 months. Bone union was observed in 46 patients (93.9%). Mean time to union was 3.1 months. Nonunion rate was 6.1%. Overall complication rate was 12.2%. Mean pre- and postoperative VAS scores were 7.5 and 0.2, respectively (P < .0001). Mean pre- and postoperative total FFI values were 56.3 and 15.7 (P < .0001), respectively. Patient satisfaction after the procedure was 93.9%.
Observed union rate is comparable to the average fusion rate previously reported for open and minimally invasive procedure union rates. Mean time to union was observed to be comparable to open procedures union time. Observed overall complication rate is similar to those reported for open techniques as well. Patient reported outcomes demonstrated a significant reduction in postoperative VAS and FFI for the percutaneous metatarsophalangeal arthrodesis with calcaneus bone autograft. Patient satisfaction rates compared favorably to those reported following open surgery.
对于终末期僵硬性拇趾，第一跖趾（MTP）关节融合术是金标准，传统上通过开放手术进行。然而，据报道，诸如不愈合等并发症的发生率高达30%。最近，有报道表明经皮手术方法是有效且安全的。
49例终末期僵硬性拇趾患者由同一外科医生进行了带跟骨自体移植的经皮第一跖趾关节融合术。每位患者至少接受了24个月的临床和影像学随访，包括术后3个月的计算机断层扫描。术前及末次随访时使用视觉模拟量表（VAS）和足部功能指数（FFI）评估临床结果。
平均随访27.3个月。46例患者（93.9%）观察到骨愈合。平均愈合时间为3.1个月。不愈合率为6.1%。总体并发症发生率为12.2%。术前和术后VAS评分的平均值分别为7.5和0.2（P <.0001）。术前和术后总FFI值的平均值分别为56.3和15.7（P <.0001）。术后患者满意度为93.9%。
观察到的愈合率与先前报道的开放手术和微创手术的平均融合率相当。观察到的平均愈合时间与开放手术的愈合时间相当。观察到的总体并发症发生率也与开放技术报道的相似。患者报告的结果表明，带跟骨自体移植的经皮跖趾关节融合术后VAS和FFI显著降低。患者满意度与开放手术后报道的结果相比更有利。
