The efficacy of derotation of talus and medial column fusion for Müller-Weiss disease / 中华骨科杂志

ABSTRACT

Objective To explore the mid-term efficacy of derotation of talus and medial column fusion for stage Ⅱ-Ⅴ Müller-Weiss disease (MWD).Methods Data of thirty-six patients (38 feet) with MWD treated by derotation of talus and talonavicular (tTN) or talonavicular-cuneiform (TNC) arthrodesis in our center during January 2008 to December 2016 were retrospectively analyzed.There were 3 males (3 feet) and 33 females (35 feet) with an average age of 54.0±9.2 years old (range,32-80 years old);there were 11 right feet and 27 left feet.According to Maceira and Rochera staging system,there were 9 stage Ⅱ cases,11 stage Ⅲ cases,10 stage Ⅳ cases and 8 stage Ⅴ cases.The external rotation of talus was intensively focused.After the TN articular surface was debrided,an "H" shape plate and a hollow lag screw were used to firmly fix the TN or TNC joint.American Orthopaedic Foot and Ankle Society Scale (AOFAS),visual analog scale (VAS) and relative radiological parameters were evaluated preoperatively and during follow-up.Results The mean follow-up duration was 37.2 months (range,25-113 months).The latest follow-up showed satisfactory outcomes.Overall,AOFAS score was improved from 41.3± 11.3 points (range,20-56 points) preoperatively to 85.5±7.1 points (range,68-100 points) postoperatively (Z=5.16,P＜ 0.001),and the VAS score was reduced from 5.6±1.5 points (range,3-8 points) preoperatively to 0.8± 1.2 points (range,0-4 points) postoperatively (Z=5.19,P＜ 0.001).These differences of functional score and pain evaluation were statistically significant.The Tomeno-Méary angle decreased from-6.6°± 12.2° to 0.5°± 2.9° (Z=3.43,P=0.001);the calcaneal pitch angle increased from 13.5°±3.9° to 22.1 °±3.4°(t=10.12,P＜ 0.001),and the talarnavicular coverage angle decreased from 27.1°±5.9° to 7.6°±3.3°(Z=5.16,P＜ 0.001).The AP talar-first metatarsal angle decreased from-16.0°±10.7° to-7.0°±8.5°(t=5.49,P＜ 0.001).The differences of radiological parameters were statistically significant.Conclusion The mid-term results showed that the TN or TNC joint fusion could achieve a favorable clinical and radiological outcome for MWD patients.Even for the patients with severe deformities (stage Ⅱ-Ⅴ),such treatment strategy could also achieve satisfactory deformity correction and functional improvement.Intraoperative restoration of talus rotation is the key to normal alignment of the subtalar joint / TN joint.