Berner Alissa, Sage Ronald, Niemela John
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
J Foot Ankle Surg. 2005 Mar-Apr;44(2):133-6. doi: 10.1053/j.jfas.2005.01.004.
A retrospective chart review was performed on 11 patients (13 feet) who underwent a modified Keller procedure for the treatment of recalcitrant neuropathic diabetic ulcers to the plantar aspect of the hallux between 1994 and 1998 to evaluate the postoperative results and complications. Diabetic patients with hallux rigidus, adequate vascular status, documented peripheral neuropathy, and at least 6 months of conservative care for treatment of a Wagner grade I and II ulceration were included in the study. Patients with active soft tissue infections or osteomyelitis were excluded. All primary ulcers healed within 6 months postoperatively. After 1-year of follow-up, 8 feet remained completely free of ulcers and 5 transfer ulcers occurred. Four infections developed; 3 from the surgical wound and 1 from a transfer ulcer. Based on these findings, the modified Keller procedure may be an appropriate intervention for hallux ulcerations provided the surgeon and the patient are aware of its limitations and possible outcomes.
对1994年至1998年间接受改良凯勒手术治疗拇趾足底顽固性神经性糖尿病溃疡的11例患者（13只脚）进行了回顾性病历审查，以评估术后结果和并发症。研究纳入了患有拇僵硬症、血管状况良好、有记录的周围神经病变且至少接受6个月保守治疗以治疗瓦格纳I级和II级溃疡的糖尿病患者。排除有活动性软组织感染或骨髓炎的患者。所有原发性溃疡在术后6个月内愈合。随访1年后，8只脚完全无溃疡，发生了5处转移性溃疡。出现了4例感染；3例来自手术伤口，1例来自转移性溃疡。基于这些发现，改良凯勒手术可能是治疗拇趾溃疡的一种合适干预措施，前提是外科医生和患者了解其局限性和可能的结果。
