Abstract：
BACKGROUND: Mueller-Weiss disease is a rarely diagnosed deformity where the navicular bone undergoes spontaneous osteonecrosis in adults. Until now, there is no widely accepted operative treatment for this unusual disease. We aimed to compare clinical and radiological outcomes between the open triple fusion and talonavicular-cuneiform arthrodesis for Mueller-Weiss disease of stage 4.
METHODS: During the period from February 2012 to June 2016, 10 patients (11 feet) suffering from Mueller-Weiss disease of stage 4 were treated by the same senior surgeon. Among them, 5 patients (5 feet) were treated with open triple fusion and 5 patients (6 feet) were treated with talonavicular-cuneiform arthrodesis. Clinical outcomes were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Radiological results were assessed based on the X-ray and CT. Postoperative complications were also recorded.
RESULTS: There were no significant differences in AOFAS score between the two groups (p = 0.1 > 0.05). For the open triple fusion, the average AOFAS ankle-hindfoot score improved from 30.2 ± 3.27 preoperatively to 79 ± 3.81 at the last follow-up (p = 0.008). And for the talonavicular-cuneiform (TNC) arthrodesis, the average AOFAS ankle-hindfoot score improved from 33.2 ± 5.63 preoperatively to 86.2 ± 3.49 at the last follow-up (p = 0.007).
CONCLUSIONS: Both triple fusion and TNC arthrodesis are reasonable methods for the treatment of Mueller-Weiss disease if properly used. It is crucial to use radiological assessment to evaluate the involved joints preoperatively and then chose the appropriate method to treat different patients.
METHODS: During the period from February 2012 to June 2016, 10 patients (11 feet) suffering from Mueller-Weiss disease of stage 4 were treated by the same senior surgeon. Among them, 5 patients (5 feet) were treated with open triple fusion and 5 patients (6 feet) were treated with talonavicular-cuneiform arthrodesis. Clinical outcomes were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Radiological results were assessed based on the X-ray and CT. Postoperative complications were also recorded.
RESULTS: There were no significant differences in AOFAS score between the two groups (p = 0.1 > 0.05). For the open triple fusion, the average AOFAS ankle-hindfoot score improved from 30.2 ± 3.27 preoperatively to 79 ± 3.81 at the last follow-up (p = 0.008). And for the talonavicular-cuneiform (TNC) arthrodesis, the average AOFAS ankle-hindfoot score improved from 33.2 ± 5.63 preoperatively to 86.2 ± 3.49 at the last follow-up (p = 0.007).
CONCLUSIONS: Both triple fusion and TNC arthrodesis are reasonable methods for the treatment of Mueller-Weiss disease if properly used. It is crucial to use radiological assessment to evaluate the involved joints preoperatively and then chose the appropriate method to treat different patients.
摘要：
背景：Mueller-Weiss病是一种罕见的畸形，在成人中，舟骨发生自发性骨坏死。直到现在,对于这种不寻常的疾病，没有广泛接受的手术治疗。我们旨在比较开放式三重融合和距骨楔形关节固定术治疗4期Mueller-Weiss病的临床和放射学结果。
方法：在2012年2月至2016年6月期间，由同一高级外科医生治疗了10例（11英尺）患有Mueller-Weiss疾病4期的患者。其中,5例患者（5英尺）接受开放式三重融合治疗，5例患者（6英尺）接受距骨-楔状关节固定术治疗。通过美国骨科足踝协会（AOFAS）踝足-后足评分评估临床结果。根据X射线和CT评估放射学结果。记录术后并发症。
结果：两组之间的AOFAS评分没有显着差异（p=0.1>0.05）。对于开放式三重融合，AOFAS踝足平均评分从术前30.2±3.27提高到末次随访时的79±3.81(p=0.008)。对于距骨楔形骨（TNC）关节固定术，AOFAS踝足-后足平均评分从术前的33.2±5.63提高到末次随访时的86.2±3.49(p=0.007)。
结论：如果使用得当，三联融合和TNC关节固定术都是治疗Mueller-Weiss病的合理方法。术前使用放射学评估来评估受累关节，然后选择合适的方法来治疗不同的患者是至关重要的。
方法：在2012年2月至2016年6月期间，由同一高级外科医生治疗了10例（11英尺）患有Mueller-Weiss疾病4期的患者。其中,5例患者（5英尺）接受开放式三重融合治疗，5例患者（6英尺）接受距骨-楔状关节固定术治疗。通过美国骨科足踝协会（AOFAS）踝足-后足评分评估临床结果。根据X射线和CT评估放射学结果。记录术后并发症。
结果：两组之间的AOFAS评分没有显着差异（p=0.1>0.05）。对于开放式三重融合，AOFAS踝足平均评分从术前30.2±3.27提高到末次随访时的79±3.81(p=0.008)。对于距骨楔形骨（TNC）关节固定术，AOFAS踝足-后足平均评分从术前的33.2±5.63提高到末次随访时的86.2±3.49(p=0.007)。
结论：如果使用得当，三联融合和TNC关节固定术都是治疗Mueller-Weiss病的合理方法。术前使用放射学评估来评估受累关节，然后选择合适的方法来治疗不同的患者是至关重要的。
