背景:内侧柱的不稳定/塌陷与许多情况有关,尤其是进行性塌陷性足部畸形(PCFD),外翻(HV),和中足关节炎(MA)。在治疗这些畸形时,必须恢复第一射线长度和矢状面对齐以恢复脚三脚架。这项研究旨在评估早期结果,愈合,在内侧柱塌陷/不稳定的患者中,牵开背侧开放pi屈楔形同种异体移植的第一骨掌关节融合(LapiCotton程序)的并发症发生率。
方法:在这项前瞻性队列研究中,我们包括PCFD,HV,和接受LapiCotton手术的MA患者。3个月后,使用负重计算机断层扫描(WBCT),在同种异体移植物楔形和宿主骨之间的两个界面中,>50%的骨桥接定义为融合部位愈合。首次射线塌陷射线照相校正和次要和主要并发症(深度裂开,深部感染,和再次手术)进行了评估。
结果:共纳入22例患者(22英尺)(11例PCFD,6MA,和5例HV患者)。平均随访时间为5.9个月(范围3-12),中位同种异体移植物大小为8mm(范围5-19mm)。在91%的病例中观察到骨愈合。两个轻微的并发症(9%,表面裂开)和一个主要并发症(4.5%,深部感染)。观察到距骨矢状平面-第一跖骨角的统计学显着改善,平均改善9.4°(95%CI6.7-12.1°;p<0.0001)。
结论:在这项前瞻性队列研究中,22例患者采用LapiCotton手术治疗内侧纵弓塌陷/不稳定,我们观察到并发症发生率低(9%轻微,4.5%主要),3个月后愈合率高(91%),1例临床稳定的影像学不愈合(4.5%)和1例不稳定的不愈合(4.5%)需要再次手术。我们的结果证明了LapiCotton技术在治疗PCFD患者内侧纵弓塌陷方面的初步结果,MA和HV畸形。需要长期的结果来证实这些有希望的结果。
方法:二级,前瞻性队列研究。
BACKGROUND: Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (
PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column.
METHODS: In this prospective cohort study, we included
PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed.
RESULTS: A total of 22 patients (22 feet) were included (11
PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3-12) and median allograft size was 8 mm (range 5-19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7-12.1°; p < 0.0001).
CONCLUSIONS: In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with
PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results.
METHODS: Level II, prospective cohort study.