Artrodesis tipo lapidus para corrección de hallux valgus: comparación de fijación con tornillos canulados y sistema poste tornillo
Autores
Lores García, Francisco Javier
Director
García Bermúdez, Francisco Javier
Tipo de contenido
Trabajo de grado - Especialidad Médica
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EspañolFecha de publicación
2020-02-08
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Resumen
Introducción: Hallux valgus Es la patología más frecuente del Hallux y dolor es la principal
indicación quirúrgica, actualmente están descritas más de 100 técnicas quirúrgicas
correctivas. En este estudio realizamos una comparación entre la fijación con tornillos
canulados y la fijación con sistema poste tornillo para artrodesis cuneometatarsiana tipo
lapidus, en la literatura disponible hasta el momento no existen estudios en pacientes al
respecto.
Metodología: Estudio de cohortes retrospectivo, observacional, comparativo con selección
de individuos con diagnóstico de Hallux Valgus moderado a severo que hayan sido
intervenidos quirúrgicamente para corrección de la deformidad con artrodesis tipo lapidus.
Resultados: 17 casos de hallux valgus, intervenidos con artrodesis tarsometatarsiana con
técnica lapidus,. 16 casos fueron de sexon femenino y un solo caso de sexo masculino,
promedio de edad fue de 52 años. 88.2% severos y 21.8% fueron moderados. 6 casos se
realizaron con sistema poste/tornillo y 11 casos con tornillos canulados. El grupo con
sistema poste/tornillo presentó un 16.6% de no unión y el grupo de tornillos canulados un
9%.
Discusión: Se encontraron tasas de no unión similares a las reportadas en la literatura con
los dos métodos evaluados, siendo para el caso de estudio mayor el porcentaje de no unión
con el sistema poste/tornillo, lo que sugiete tendencia a la superioridad de los tornillos
canulados, sin embargo no es fue posible establecer de manera estadísticamente
significativa la superioridad de una de las dos técnicas, por lo cual se requieren estudios
prospectivos adicionales y con mayor población. Hubo un número de casos
significativamente mayor de casos intervenidos con sistema de tornillos canulados y 2 casos
de sistema poste/tornillo tuvieron que ser descartados por no haberse podido completar el
seguimiento lo cual podría ser un sesgo. Conclusiones : El sistema poste / tornillo es una
opción efectiva para artrodesis cuneometatarsiana tipo lapidus, con tasas de no unión y
complicaciones similares a las descritas en la literatura con otros métodos de fijación. En
este estudio no fue posible evaluar la significancia estadística pero comparativamente
parece haber una tendencia a la superioridad de los tornillos canulados, sin embargo se
necesitan estudios prospectivos con una mayor población. El sistema poste / tornillo es una
buena alternativa para el manejo de no unión en cirugías de revisión de este tipo de
artrodesis.
Introduction: Hallux valgus It is the most frequent pathology of hallux and pain is the main surgical indication, more than 100 corrective surgical techniques are currently described. In this study we made a comparison between fixation with cannulated screws and fixation with screw post system for cuneometatarsal lapidus arthrodesis, there are no available studies published in literature about this topic. Methodology: A retrospective, observational, comparative cohort study with selection of individuals diagnosed with moderate to severe Hallux Valgus who have undergone surgery with lapidus arthrodesis to correct the deformity.. Results: 17 cases of hallux valgus, operated with tarsometatarsal arthrodesis with lapidus technique. 16 cases were female and only one male case, average age was 52 years. 88.2% with severe deformity and 21.8% were moderate. 6 cases were performed with post / screw system and 11 cases with cannulated screws. We found a 16.6% of non union in group managed with post / screw system and 9% in the group of cannulated screws technique. Discussion: Non-union rates found in this study were similar to those reported in the literature with bothmethods evaluated, with the higher percentage of non-union with post / screw system in our case suggesting a possible superiority of cannulated screw technique, however it was no possible to establish statistical significance to probe the superiority of one of techniques, for which additional prospective studies with a larger population are required. There were a significantly greater number of cases operated with cannulated screw system and 2 cases of post / screw system had to be ruled out because they could not complete the follow-up which could be a bias. Conclusions: The post / screw system is an effective option for lapidus cuneometatarsal arthrodesis, with non-binding rates and complications similar to those described in the literature with other fixation methods. In this study it was not possible to evaluate the statistical significance but comparatively there seems to be a tendency to the superiority of cannulated screws, however prospective studies with a larger population are needed. The post / screw system is a good alternative for the management of non-union in revision surgeries of this type of arthrodesis.
Introduction: Hallux valgus It is the most frequent pathology of hallux and pain is the main surgical indication, more than 100 corrective surgical techniques are currently described. In this study we made a comparison between fixation with cannulated screws and fixation with screw post system for cuneometatarsal lapidus arthrodesis, there are no available studies published in literature about this topic. Methodology: A retrospective, observational, comparative cohort study with selection of individuals diagnosed with moderate to severe Hallux Valgus who have undergone surgery with lapidus arthrodesis to correct the deformity.. Results: 17 cases of hallux valgus, operated with tarsometatarsal arthrodesis with lapidus technique. 16 cases were female and only one male case, average age was 52 years. 88.2% with severe deformity and 21.8% were moderate. 6 cases were performed with post / screw system and 11 cases with cannulated screws. We found a 16.6% of non union in group managed with post / screw system and 9% in the group of cannulated screws technique. Discussion: Non-union rates found in this study were similar to those reported in the literature with bothmethods evaluated, with the higher percentage of non-union with post / screw system in our case suggesting a possible superiority of cannulated screw technique, however it was no possible to establish statistical significance to probe the superiority of one of techniques, for which additional prospective studies with a larger population are required. There were a significantly greater number of cases operated with cannulated screw system and 2 cases of post / screw system had to be ruled out because they could not complete the follow-up which could be a bias. Conclusions: The post / screw system is an effective option for lapidus cuneometatarsal arthrodesis, with non-binding rates and complications similar to those described in the literature with other fixation methods. In this study it was not possible to evaluate the statistical significance but comparatively there seems to be a tendency to the superiority of cannulated screws, however prospective studies with a larger population are needed. The post / screw system is a good alternative for the management of non-union in revision surgeries of this type of arthrodesis.