Wout Füssenich, Gesine H Seeber, Tom M van Raaij, Christiaan P van Lingen, Rutger G Zuurmond, Martin Stevens, Matthijs P Somford
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Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion.</p><p><strong>Results: </strong>Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index.</p><p><strong>Conclusion: </strong>Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. 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引用次数: 0
摘要
背景:第一跖趾关节融合术是目前治疗症状性晚期拇趾僵硬和中重度拇趾外翻的首选方法。有不同的方法进行关节融合术，但没有共识的最佳方法。因此，本研究旨在确定术前和术后拇外翻角(HVA)、关节准备和固定技术以及术后固定对不愈合发生率的影响。方法:采用回顾性多中心队列研究，纳入794例患者。采用单因素和多因素logistic回归来确定关节准备、固定技术、术后固定、负重、术前和术后HVA与骨不连之间的关系。结果:骨不连发生率为15.2%，有症状者11.1%。与平面切割相比，使用手动器械(OR 3.75, CI 1.90-7.42)和凸/凹铰刀(OR 2.80, CI 1.52-5.16)进行关节准备与更大的不愈合几率相关。交叉螺钉固定关节与骨不连的几率较高相关(OR 2.00, CI 1.11-3.42)，术前HVA也较高(OR 1.02, CI 1.00-1.03)。然而，在模型中纳入术后HVA后，后一种效应消失，术后残留HVA与骨不连之间存在较小的关联(OR 1.04, CI 1.01-1.08)。同样，我们发现骨不连的几率与较高的体重有关(OR 1.02, CI 1.01-1.04)，但与体重指数无关。结论:根据我们的研究结果，第一跖趾关节融合术采用平面切口，并用钢板和骨折间螺钉固定，导致骨不愈合的几率最低。较高的体重和较高的术前HVA与骨不愈合率的轻微增加有关。手术中正确矫正拇外翻畸形至关重要。证据等级:III级，回顾性病例对照研究。
Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study.
Background: Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion.
Methods: A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion.
Results: Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index.
Conclusion: Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery.
Level of evidence: Level III, retrospective case control study.
期刊介绍：
Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers.
The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008.
The journal focuses on the following areas of interest:
• Surgery
• Wound care
• Bone healing
• Pain management
• In-office orthotic systems
• Diabetes
• Sports medicine
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