Fullmer Taylor C, Thompson Rosemary J, Elliott Andrew D
*Gundersen Health System, La Crosse, WI.
J Am Podiatr Med Assoc. 2025 May-Jun;115(3). doi: 10.7547/24-037.
In recent years, the Lapidus procedure has undergone adaptation to embrace the minimally invasive guidelines that are currently gaining traction in the United States. However, because of the steep learning curve associated with minimally invasive surgery and the lack of literature based on long-term outcomes, the procedure is still a long way from replacing open surgical techniques. To date, the incidence of complications with this updated technique has not been evaluated.
The purpose of this systematic review was to determine the incidence of complications for the Lapidus procedure. We conducted a systematic review of electronic databases and relevant peer-reviewed sources as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the preparation of systematic reviews. Studies that included the minimally invasive surgical technique of Lapidus (or tarsometatarsal fusion), used fixation, had a minimum average follow-up of 6 months, and included complications were considered. Some of the studies included patients with concomitant procedures. The included studies did not report on comorbidities. Cadaveric studies, technique guides, and non-English studies were excluded.
A total of five studies were identified that met our inclusion criteria, with a total of 162 feet included. Total incidence of complications was 12.3% (n = 20) and the most commonly reported complications included hardware pain (n = 9), nonunion (n = 5), deformity recurrence (n = 3), and neurovascular injury (n = 3).
Our systematic review revealed that this updated minimally invasive surgical technique provides a safe and reproducible surgical option for correcting deformities of the first ray requiring tarsometatarsal fusion, with an incidence of complications lower than what is currently reported in the literature for open variations of the procedure.
近年来，拉皮德斯手术已进行调整，以符合目前在美国越来越受关注的微创指南。然而，由于与微创手术相关的陡峭学习曲线以及缺乏基于长期结果的文献，该手术距离取代开放手术技术仍有很长的路要走。迄今为止，这种更新技术的并发症发生率尚未得到评估。
本系统评价的目的是确定拉皮德斯手术的并发症发生率。我们按照系统评价和Meta分析的首选报告项目指南对电子数据库和相关同行评审来源进行了系统评价，以准备系统评价。纳入的研究包括拉皮德斯（或跗跖关节融合）的微创外科技术、使用内固定、平均随访至少6个月且包括并发症的研究。一些研究纳入了同时进行其他手术的患者。纳入的研究未报告合并症情况。尸体研究、技术指南和非英文研究被排除。
共确定了五项符合我们纳入标准的研究，共纳入162只足。并发症总发生率为12.3%（n = 20），最常报告的并发症包括内固定疼痛（n = 9）、骨不连（n = 5）、畸形复发（n = 3）和神经血管损伤（n = 3）。
我们的系统评价显示，这种更新的微创外科技术为矫正需要跗跖关节融合的第一跖骨畸形提供了一种安全且可重复的手术选择，其并发症发生率低于目前文献中报道的该手术开放术式的发生率。
