■改良的Lapidus(ML)是一种强大的程序,用于使用新兴技术矫正外翻(HV)。考虑患者报告结果的研究,射线照相测量,并发症,和植入成本目前是有限的。
■前瞻性收集患者报告结果信息系统身体功能(PROMIS-PF)计算机自适应测试(CAT)评分的回顾性队列,放射学参数(meta骨间角,IMA;外翻角,HVA;和胫骨籽骨位置,TSP),并发症,回顾了2014年至2019年的总手术时间和植入成本。
■七十三英尺(68例患者)接受了用方头螺钉固定的ML法进行的眼袋矫正。中位年龄为55.8岁(IQR45.6,53.9),73人中有4人(5.5%)是男性,73人中有11人(15.1%)是吸烟者,73人中有15人(20.6%)是糖尿病患者(HbA1c中位数为6.4%[IQR6.0,7.4],无胰岛素依赖性,15个中的5个患有神经病)。并发症包括通过局部或口腔治疗解决的73例伤口问题中的6例(8.2%),73个中的9个(12.3%)需要拆卸硬件的痛苦或损坏的硬件。73人中有2人(2.7%)尽管合并但仍持续疼痛。73人中有1人(1.4%)过度矫正,需要首次MTP关节固定术。在3个不结合(2.7%)中,1纠正甲状腺功能减退症,1无症状,不需要治疗,1例外翻复发,并在其他地方寻求翻修手术。术前射线照相角度为HVA35度,IMA14度,在最终的术后随访中改善至HVA10度,IMA6度。胫骨种骨位置从6.05±1.00提高到2.22±1.38。32例患者术前,42例患者术后1年。术前PROMIS-PF(51%的收集率)为43(IQR37,52),37(31,39)在6周,46(42,51)在3个月,和49(41,53)在术后>360天。PROMIS-PF在术前和6周之间的下降以及从6周到3个月的上升具有统计学意义。术前、术后PROMIS-PF评分无明显差异。植入物成本平均为146美元。
■我们报告低并发症发生率和费用,患者术后功能和影像学结果高。PROMIS-PF术后急剧下降,但在术后3个月恢复并保持高水平。
■四级,案例系列。
UNASSIGNED: The modified
Lapidus (ML) is a powerful procedure for correction of hallux valgus (HV) with emerging techniques. Studies considering patient-reported outcomes, radiographic measures, complications, and implant costs are currently limited.
UNASSIGNED: Retrospective cohort with prospectively collected Patient Reported Outcome Information System Physical Function (PROMIS-PF) Computerized Adaptive Test (CAT) scores, radiographic parameters (intermetatarsal angle, IMA; hallux valgus angle, HVA; and tibial sesamoid position, TSP), complications, and total operative time and implant costs were reviewed from 2014 to 2019.
UNASSIGNED: Seventy-three feet (68 patients) underwent bunion correction by ML with lag-screw fixation. Median age was 55.8 years (IQR 45.6, 53.9), 4 of 73 (5.5%) were male, 11 of 73 (15.1%) were smokers, and 15 of 73 (20.6%) were diabetic (median HbA1c 6.4% [IQR 6.0, 7.4], none insulin dependent, 5 of 15 with neuropathy). Complications included 6 of 73 (8.2%) wound issues resolved with topical or oral treatment, 9 of 73 (12.3%) painful or broken hardware requiring hardware removal. Two of 73 (2.7%) had persistent pain despite union. One of 73 (1.4%) was overcorrected and required first MTP arthrodesis. Of 3 nonunions (2.7%), 1 resolved with corrected hypothyroidism, 1 was asymptomatic and required no treatment, 1 had a hallux valgus recurrence and sought revision surgery elsewhere. Preoperative radiographic angles were HVA 35 degrees, IMA 14 degrees which improved at final postoperative follow up to HVA 10 degrees, IMA 6 degrees. Tibial sesamoid position improved from 6.05 ± 1.00 to 2.22 ± 1.38. Thirty-two patients had preoperative and 42 had 1-year postoperative outcomes. PROMIS-PF (51% collection rate) was 43 (IQR 37,52) preoperatively, 37 (31, 39) at 6 weeks, 46 (42, 51) at 3 months, and 49 (41, 53) at >360 days postoperatively. The drop in PROMIS-PF between preoperative and 6 weeks and the rise from 6 weeks to 3 months were statistically significant. Pre- and postoperative PROMIS-PF scores were not significantly different. Implant cost averaged US$146.
UNASSIGNED: We report low complication rates and costs with high patient postoperative functional and radiographic outcomes. PROMIS-PF decreased acutely postoperatively but recovered and maintained high levels by 3 months postoperatively.
UNASSIGNED: Level IV, case series.