目的:hallux硬体(HR)的治疗范围很广,包括保守方法和手术方法,如关节成形术和关节固定术。本研究旨在评估第一meta趾关节全关节置换术(MTPJ1TA)失败后关节固定术的翻修结果。
方法:回顾了2020年1月1日至2024年1月1日在两个高级骨科中心接受手术的患者。对术后随访至少6个月的患者进行人口统计学评估(性别,年龄,side),再操作率,并发症,视觉模拟评分(VAS)评分,足踝残疾指数(FADI)评分,和美国矫形外科足踝协会halluxmeta趾和指间量表(AOFAS-HMI)评分。放射学评估包括外翻角(HVA),meta骨间角(IMA),背屈角度(DFA),和第一射线长度(FRL)在前后和侧向视图。
结果:在27例患者中,4名男性(15%)和23名女性(85%),平均年龄56.18±7.49岁(范围41-72岁)。26例患者进行了关节固定术,由于植入失败而需要再次手术。平均VAS评分术前为7.14,术后为3.55(p<0.05)。平均FADI评分术前为50.51,术后为71.51(p<0.05)。平均AOFAS-HMI评分术前为51.22,术后为70.59(p<0.05)。平均HVA术前为19.7°,术后为6.29°(p<0.05)。平均IMA术前为10.66°,术后为11.37°(p=0.406)。术前平均DFA为34.14°,术后平均为22.33°(p<0.05)。平均前后FRL术前为10.17cm,术后为10.77cm(p<0.05)。平均外侧FRL术前为10.12cm,术后为10.42cm(p<0.05)。研究中的患者均未出现术后供体部位并发症或转移跖骨痛,同时观察到100%的骨愈合率。
结论:我们认为采用关节固定术修正MTPJ1TA是一种安全的治疗选择。此外,使用自体髂骨移植可能是恢复骨骼储备和创造有利于融合的生物环境的可行选择。这项研究评估了最大的MTPJ1TA失败患者组的关节固定术翻修手术,强调其在该领域的重要性。然而,需要进一步的研究来确定理想的手术方式.
OBJECTIVE: The treatments for hallux rigidus (HR) encompass a wide spectrum, including conservative methods and surgical approaches such as arthroplasty and arthrodesis. This study aims to evaluate the outcomes of revision with arthrodesis following the failure of the first metatarsophalangeal joint total arthroplasty (MTPJ1TA).
METHODS: Patients who had surgery at two advanced orthopedic centers between January 1, 2020, and January 1, 2024, were reviewed. Those with at least 6 months of postoperative follow-up were assessed for demographics (gender, age, side), reoperation rates, complications, Visual Analogue Scale (VAS) scores, Foot and Ankle Disability Index (FADI) scores, and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal and Interphalangeal Scale (AOFAS-HMI) scores. Radiological evaluations included hallux valgus angle (HVA), intermetatarsal angle (IMA), dorsiflexion angle (DFA), and first ray length (FRL) in anteroposterior and lateral views.
RESULTS: Of 27 patients, 4 were male (15%) and 23 female (85%), with an average age of 56.18 ± 7.49 years (range 41-72). Arthrodesis was performed in 26 patients, with one requiring reoperation due to implant failure. Average VAS scores were 7.14 preoperatively and 3.55 postoperatively (p < 0.05). Average FADI scores were 50.51 preoperatively and 71.51 postoperatively (p < 0.05). Average AOFAS-HMI scores were 51.22 preoperatively and 70.59 postoperatively (p < 0.05). Average HVA was 19.7° preoperatively and 6.29° postoperatively (p < 0.05). Average IMA was 10.66° preoperatively and 11.37° postoperatively (p = 0.406). Average DFA was 34.14° preoperatively and 22.33° postoperatively (p < 0.05). Average anteroposterior FRL was 10.17 cm preoperatively and 10.77 cm postoperatively (p < 0.05). Average lateral FRL was 10.12 cm preoperatively and 10.42 cm postoperatively (p < 0.05). None of the patients in the study exhibited postoperative donor site complications or transfer metatarsalgia, while a 100% rate of bone union was observed.
CONCLUSIONS: We think that revision of MTPJ1TA with arthrodesis is a safe treatment option. Additionally, the use of an iliac crest autograft can be a viable option to restore bone stock and create a biological environment conducive to fusion. This study evaluates revision surgery with arthrodesis in the largest patient group with failed MTPJ1TA, highlighting its significance in the field. However, further studies are needed to determine the ideal surgical procedure.