Objective: To compare the effectiveness of talonavicular-cuneiform joint fusion with iliac bone grafting and without bone grafting in the treatment of Müller-Weiss diseases (MWD).
Methods: The clinical data of 44 patients (44 feet) with MWD who received talonavicular-cuneiform joint fusion between January 2017 and November 2022 and met the selection criteria was retrospectively analyzed. Among them, 25 patients were treated with structural iliac bone grafting (bone grafting group) and 19 patients without bone grafting (non-bone grafting group). There was no significant difference ( P>0.05) in age, gender composition, body mass index, disease duration, affected side, Maceira stage, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, anteroposterior/lateral Meary angle, and Pitch angle between the two groups. Operation time, operation cost, and postoperative complications were recorded in the two groups. AOFAS and VAS scores were used to evaluate the function and pain degree of the affected foot. Meary angle and Pitch angle were measured on the X-ray film, and the joint fusion was observed after operation. The difference (change value) of the above indexes before and after operation was calculated for comparison between groups to evaluate the difference in effectiveness.
Results: The operation was successfully completed in both groups, and the incisions in the two groups healed by first intention. The operation time and cost in the bone grafting group were significantly more than those in the non-bone grafting group ( P<0.05). All patients were followed up. The median follow-up time was 41.0 months (range, 16-77 months) in the non-bone grafting group and 40.0 months (range, 16-80 months) in the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case, internal fixation stimulation in 2 cases, and pain at the iliac bone harvesting area in 1 case of the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case and muscle atrophy of the lower limb in 1 case of the non-bone grafting group. There was no significant difference in the incidence of complications between the two groups ( P>0.05). At last follow-up, the AOFAS scores of the two groups significantly improved when compared with those before operation, while the VAS scores significantly decreased, the anteroposterior/lateral Meary angle and Pitch angle significantly improved, and the differences were significant ( P<0.05). There was no significant difference in the change values of outcome indicators between the two groups ( P>0.05). There was no delayed bone union or bone nonunion in both groups, and joint fusion was achieved at last follow-up.
Conclusion: In the treatment of MWD, there is no significant difference in effectiveness and imaging improvement of talonavicular-cuneiform joint fusion combined with or without bone grafting. However, non-bone grafting can shorten the operation time, reduce the cost, and may avoid the complications of bone donor site.
目的: 比较距舟楔关节融合术中髂骨植骨与不植骨治疗Müller-Weiss病（Müller-Weiss diseases，MWD）的临床疗效。.
方法: 回顾性分析2017年1月—2022年11月接受距舟楔关节融合术治疗且符合选择标准的44例（44足）MWD患者临床资料。其中25例术中行自体髂骨结构性植骨（植骨组），19例不植骨（未植骨组）。两组患者年龄、性别构成、身体质量指数、病程、侧别、Maceira分期以及术前美国矫形足踝协会（AOFAS）评分、疼痛视觉模拟评分（VAS）、正/侧位Meary角、Pitch角等基线资料比较，差异均无统计学意义（ P>0.05）。记录两组手术时间、手术费用及术后相关并发症发生情况；采用AOFAS评分、VAS评分评价患足功能及疼痛程度；基于X线片测量正/侧位Meary角以及Pitch角，术后观察关节骨性融合情况。计算上述指标手术前后差值（变化值）进行组间比较，评价疗效差异。.
结果: 两组手术均顺利完成，术后切口均Ⅰ期愈合。植骨组手术时间及手术费用均多于未植骨组，差异有统计学意义（ P<0.05）。患者均获随访，未植骨组随访时间16～77个月，中位时间41.0个月；植骨组为16～80个月，中位时间40.0个月。植骨组发生足背内侧皮肤麻木1例、内固定物刺激2例、髂骨取骨区疼痛1例，未植骨组足背内侧皮肤麻木1例、小腿肌肉萎缩1例；两组并发生发生率比较，差异无统计学意义（ P>0.05）。末次随访时两组AOFAS评分较术前提高、VAS评分下降，正/侧位Meary角以及Pitch角均改善，差异有统计学意义（ P<0.05）；上述指标变化值组间差异均无统计学意义（ P>0.05）。两组均无骨延迟愈合、骨不连发生，末次随访时均达到关节骨性融合。.
结论: 距舟楔关节融合术治疗MWD时，联合自体髂骨植骨或不植骨处理的临床疗效和影像学改善程度无明显差异。但不植骨处理可缩短手术时间及手术费用，并且可以避免因自体取骨引发的取骨供区并发症。.
Keywords: Müller-Weiss disease; iliac bone graft; talonavicular-cuneiform joint fusion.