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나사못을 이용한 제 1 중족 족지 관절 유합술

The First Metatarsophalangeal Arthrodesis with Screws Fixation

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초록

Purpose: The aim of this study was to retrospectively evaluate the clinical and radiological results of the first metatarsophalangeal joint arthrodesis with two crossed screws fixation. Materials and Methods: We treated 23 patients (24 cases) with arthrodesis of the first metatarsophalangeal joint using two crossed screws fixation between December 2000 and May 2005. There were 3 male patients and 20 female patients. Ages ranged from 28 to 74 years (mean, 50 years). Follow-up ranged from 4.1 to 8.2 years (mean, 6.5 years). The American Orthopaedic Foot and Ankle Society (AOFAS) score and their satisfaction was evaluated clinically, foot anteroposterior and lateral radiograph, radiologically. Results: Of the 24 cases, 6 had surgery for dorsal plate and screws fixation because of failure to acquire firm fixation with two crossed screws fixation. All 6 cases acquired bony union. Fusion of the hallux first metatarsophalangeal joint occurred in 16/18 cases (89%). Nonunion occurred in 2 cases (11%) and was asymptomatic. At last follow-up, hallux valgus angle ranged from 11 to 25 degrees(mean, 17.7 degrees), dorsiflexion ranged from 15 to 25 degrees (mean, 22 degrees).The mean preoperative AOFAS score of 37 points(range, 28 to 45 points) improved to a mean of 77 points (range, 65~90 points) postoperatively. The result of the procedure as rated subjectively by the patient was excellent for 5 cases, good for 11 cases and fair for 2. Conclusion: Comparatively, the arthrodesis of the first metatarsophalangeal joint with crossed screws fixation showed a satisfactory clinical results, we thought that require technical attention for firm fixation in operation.

Abstract

Purpose: The aim of this study was to retrospectively evaluate the clinical and radiological results of the first metatarsophalangeal joint arthrodesis with two crossed screws fixation. Materials and Methods: We treated 23 patients (24 cases) with arthrodesis of the first metatarsophalangeal joint using two crossed screws fixation between December 2000 and May 2005. There were 3 male patients and 20 female patients. Ages ranged from 28 to 74 years (mean, 50 years). Follow-up ranged from 4.1 to 8.2 years (mean, 6.5 years). The American Orthopaedic Foot and Ankle Society (AOFAS) score and their satisfaction was evaluated clinically, foot anteroposterior and lateral radiograph, radiologically. Results: Of the 24 cases, 6 had surgery for dorsal plate and screws fixation because of failure to acquire firm fixation with two crossed screws fixation. All 6 cases acquired bony union. Fusion of the hallux first metatarsophalangeal joint occurred in 16/18 cases (89%). Nonunion occurred in 2 cases (11%) and was asymptomatic. At last follow-up, hallux valgus angle ranged from 11 to 25 degrees(mean, 17.7 degrees), dorsiflexion ranged from 15 to 25 degrees (mean, 22 degrees).The mean preoperative AOFAS score of 37 points(range, 28 to 45 points) improved to a mean of 77 points (range, 65~90 points) postoperatively. The result of the procedure as rated subjectively by the patient was excellent for 5 cases, good for 11 cases and fair for 2. Conclusion: Comparatively, the arthrodesis of the first metatarsophalangeal joint with crossed screws fixation showed a satisfactory clinical results, we thought that require technical attention for firm fixation in operation.

참고문헌 (12)

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  2. Coughlin MJ, "Arthrodesis of the first metatarsophalangeal joint with mini-fragment plate fixation", Orthopaedics, 13, pp.1037~1044 (1990)
  3. Coughlin MJ, "Conditions of the forefoot. in: Orthopaedic Sports medicine: Principles and Practice", pp.221~244 (1994), WB Saunders
  4. Coughlin MJ, "Arthrodesis of the first metatarsophalangeal joint for idiopathic hallux valgus: Intermediate results", Foot Ankle Int, 26, pp.783~792 (2005)
  5. Coughlin MJ, "Rheumatoid forefoot reconstruction. A long-term follow-up study", J Bone Joint Surg Am, 82, pp.332~341 (2000)
  6. Cronin JJ, "Intermetatarsal angle after first metatarsophalangeal joint arthrodesis for hallux valgus", Foot Ankle Int, 27, pp.104~109 (2006)
  7. Fitzgerald JA, "A review of long-term results of arthrodesis of the first metatarso-phalangeal joint", J Bone Joint Surg Br, 51, pp.488~493 (1969)
  8. Goucher NR, "Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: A prospective study", Foot Ankle Int, 27, pp.869~876 (2006)
  9. Mankey M, "Arthrodesis of the first metatarsophalangeal utilizing a dorsal plate", Presented at the Seventh Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society, Boston, Mass (1991)
  10. Mann RA, "Relationship of metatarsophalangeal joint fusion on the intermetatarsal angle", Foot Ankle, 10, pp.8~11 (1989)
  11. Neufeld SK, "Arthrodesis of the first metatarsophalangeal joint: a biomechanical study comparing memory compression staples, cannulated screws, and a dorsal plate", Foot Ankle Int, 23, pp.97~101 (2002)
  12. Politi J, "First metatarsal- phalangeal joint arthrodesis: a biomechanical assessment of stability", Foot Ankle Int, 24, pp.332~337 (2003)

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