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Abstract：
BACKGROUND: Midfoot arthrodesis is a common procedure performed both for arthritis and correction of deformity. The optimal fixation for midfoot arthrodesis has not been established, though numerous studies have been investigating the fixation techniques of midfoot arthrodesis. The purpose of this study was to compare the union rate of midfoot arthrodesis using 4 different fixation strategies and investigate risk factors of nonunion following midfoot arthrodesis.
METHODS: A retrospective chart review was performed for patients who underwent midfoot joint arthrodesis between January 2014 and May 2019. The rates of nonunion and postoperative complication were compared among 4 different fixation constructs: staple fixation, compression plate fixation, compression plate with lag screw fixation, and compression screw fixation. Predictors of nonunion following midfoot arthrodesis were investigated through a multivariable logistic regression analysis. A total of 95 patients (99 feet), including 240 midfoot joints were included in this study. The mean follow-up period was 78.4 weeks.
RESULTS: Overall, bony union was achieved in 86 out of 99 (86.9%) patients, which included 218 out of 240 (90.8%) midfoot joints. A significant difference in the nonunion rate according to the type of fixation construct was found (P = .011); the compression screw alone fixation construct was noted to have a significantly higher nonunion rate than other fixation constructs. Diabetes mellitus (odds ratio [OR] = 0.179 [95% CI: 0.059, 0.542]), the type of fixation construct (compression screw alone; OR =1.789 [95% CI: 1.071, 2.978]), lack of adjuvant bone graft (OR = 2.803 [95% CI: 1.081, 7.268], and postoperative nonanatomical alignment (OR = 3.937 [95% CI: 1.278, 12.126]) were identified as independent predictors of nonunion following midfoot arthrodesis.
CONCLUSIONS: The rate of nonunion following midfoot arthrodesis among 4 different commonly used fixation constructs was compared in this study. Risk factors of nonunion were investigated revealing that diabetes mellitus, compression screw fixation alone, lack of adjuvant bone graft, and postoperative nonanatomical alignment are independent predictors of nonunion following midfoot arthrodesis.
UNASSIGNED: Level III: Comparative cohort study.
METHODS: A retrospective chart review was performed for patients who underwent midfoot joint arthrodesis between January 2014 and May 2019. The rates of nonunion and postoperative complication were compared among 4 different fixation constructs: staple fixation, compression plate fixation, compression plate with lag screw fixation, and compression screw fixation. Predictors of nonunion following midfoot arthrodesis were investigated through a multivariable logistic regression analysis. A total of 95 patients (99 feet), including 240 midfoot joints were included in this study. The mean follow-up period was 78.4 weeks.
RESULTS: Overall, bony union was achieved in 86 out of 99 (86.9%) patients, which included 218 out of 240 (90.8%) midfoot joints. A significant difference in the nonunion rate according to the type of fixation construct was found (P = .011); the compression screw alone fixation construct was noted to have a significantly higher nonunion rate than other fixation constructs. Diabetes mellitus (odds ratio [OR] = 0.179 [95% CI: 0.059, 0.542]), the type of fixation construct (compression screw alone; OR =1.789 [95% CI: 1.071, 2.978]), lack of adjuvant bone graft (OR = 2.803 [95% CI: 1.081, 7.268], and postoperative nonanatomical alignment (OR = 3.937 [95% CI: 1.278, 12.126]) were identified as independent predictors of nonunion following midfoot arthrodesis.
CONCLUSIONS: The rate of nonunion following midfoot arthrodesis among 4 different commonly used fixation constructs was compared in this study. Risk factors of nonunion were investigated revealing that diabetes mellitus, compression screw fixation alone, lack of adjuvant bone graft, and postoperative nonanatomical alignment are independent predictors of nonunion following midfoot arthrodesis.
UNASSIGNED: Level III: Comparative cohort study.
摘要：
背景：中足关节固定术是治疗关节炎和矫正畸形的常用方法。中足关节固定术的最佳固定尚未确定，尽管许多研究一直在研究中足关节固定术的固定技术。这项研究的目的是比较使用4种不同固定策略的中足关节固定术的愈合率，并调查中足关节固定术后骨不连的危险因素。
方法：对2014年1月至2019年5月期间接受中足关节融合术的患者进行回顾性分析。比较了4种不同固定结构的骨不连发生率和术后并发症：加压钢板固定,带拉力螺钉固定的加压钢板，和加压螺钉固定。通过多变量逻辑回归分析研究了足中关节固定术后骨不连的预测因素。共有95名患者（99英尺），本研究包括240个中足关节.平均随访期为78.4周。
结果：总体而言，99名患者中有86名(86.9%)实现了骨结合，其中包括240个（90.8%）中足关节中的218个。根据固定结构的类型，骨不连的发生率存在显着差异（P=.011）；注意到单独的加压螺钉固定结构的骨不愈合率明显高于其他固定结构。糖尿病（比值比[OR]=0.179[95%CI：0.059，0.542]），固定结构的类型（单独使用加压螺钉；OR=1.789[95%CI：1.071，2.978]），缺乏辅助骨移植(OR=2.803[95%CI：1.081，7.268]，和术后非解剖排列(OR=3.937[95%CI:1.278,12.126])被确定为中足关节固定术后骨不连的独立预测因子.
结论：本研究比较了4种常用固定结构中足关节固定术后骨不连的发生率。对不愈合的危险因素进行了调查，发现糖尿病，单独加压螺钉固定，缺乏辅助骨移植，术后非解剖排列是足中关节固定术后骨不连的独立预测因素。
■III级：比较队列研究。
方法：对2014年1月至2019年5月期间接受中足关节融合术的患者进行回顾性分析。比较了4种不同固定结构的骨不连发生率和术后并发症：加压钢板固定,带拉力螺钉固定的加压钢板，和加压螺钉固定。通过多变量逻辑回归分析研究了足中关节固定术后骨不连的预测因素。共有95名患者（99英尺），本研究包括240个中足关节.平均随访期为78.4周。
结果：总体而言，99名患者中有86名(86.9%)实现了骨结合，其中包括240个（90.8%）中足关节中的218个。根据固定结构的类型，骨不连的发生率存在显着差异（P=.011）；注意到单独的加压螺钉固定结构的骨不愈合率明显高于其他固定结构。糖尿病（比值比[OR]=0.179[95%CI：0.059，0.542]），固定结构的类型（单独使用加压螺钉；OR=1.789[95%CI：1.071，2.978]），缺乏辅助骨移植(OR=2.803[95%CI：1.081，7.268]，和术后非解剖排列(OR=3.937[95%CI:1.278,12.126])被确定为中足关节固定术后骨不连的独立预测因子.
结论：本研究比较了4种常用固定结构中足关节固定术后骨不连的发生率。对不愈合的危险因素进行了调查，发现糖尿病，单独加压螺钉固定，缺乏辅助骨移植，术后非解剖排列是足中关节固定术后骨不连的独立预测因素。
■III级：比较队列研究。
