Pinzur Michael S
Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA.
Foot Ankle Int. 2007 Sep;28(9):961-6. doi: 10.3113/FAI.2007.0961.
Charcot foot arthropathy negatively impacts the health-related quality of life (HRQL) of affected individuals. The disease process often is responsible for the development of significant deformity and disability, often progressing to lower extremity amputation. Many patients are morbidly obese, immunocompromised, and have complex wounds with underlying bony infection or poor bone quality, making operative correction and internal fixation problematic.
Using a prospective clinical algorithm, 26 consecutive diabetic adults with multiple diabetic co-morbidities, including morbid obesity, had operative correction of nonplantigrade Charcot midfoot deformity at the midfoot level. Correction was maintained with a neutrally applied three-level ring external fixator. Average body mass index was 38.31 +/- 12.51. Nineteen patients used insulin. Fourteen had open wounds with underlying osteomyelitis. The altered relationship between the forefoot and hindfoot was measured as 14.04 +/- 31.09 degrees in the anteroposterior axis, and 16.70 +/- 17.47 degrees in the lateral axis before surgery. Surgery included Achilles tendon lengthening, excision of infected bone, correction of the multiplanar deformity, and culture-specific parenteral antibiotic therapy.
At a minimum 1-year followup, 24 of 26 patients were ulcer and infection free and able to ambulate with commercially-available depth-inlay shoes and custom accommodative foot orthoses. One patient died of unrelated causes, and one had transtibial amputation for persistent infection. Four developed recurrent plantar ulcers, which resolved with excision of underlying bony prominences. There were two stress fractures through olive wire pin sites, one requiring intramedullary nailing. The radiographic anteroposterior axis was corrected to 3.12 +/- 9.42 degrees, and lateral to 10.42 +/- 11.86 degrees after surgery.
Morbidly obese diabetic individuals with multiple co-morbidities complicating severe Charcot foot deformity can achieve correction of midfoot deformity after operative correction of the deformity and maintenance of that correction with a neutrally applied ring external fixator.
夏科氏足关节病对患者的健康相关生活质量（HRQL）产生负面影响。该疾病进程常导致严重畸形和残疾，常进展至下肢截肢。许多患者病态肥胖、免疫功能低下，有复杂伤口且伴有潜在骨感染或骨质不佳，使得手术矫正和内固定存在问题。
采用前瞻性临床算法，26例连续的患有多种糖尿病合并症（包括病态肥胖）的成年糖尿病患者，在中足水平对非平底足的夏科氏中足畸形进行手术矫正。使用中立应用的三级环形外固定器维持矫正。平均体重指数为38.31±12.51。19例患者使用胰岛素。14例有开放性伤口并伴有潜在骨髓炎。术前，前足与后足之间改变的关系在前轴测量为14.04±31.09度，在侧轴测量为16.70±17.47度。手术包括跟腱延长、感染骨切除、多平面畸形矫正以及针对特定培养物的肠外抗生素治疗。
在至少1年的随访中，26例患者中有24例无溃疡和感染，能够穿着市售的深嵌式鞋子和定制的适应性足部矫形器行走。1例患者死于无关原因，1例因持续性感染进行了经胫骨截肢。4例出现复发性足底溃疡，通过切除潜在的骨突出得以解决。有2例通过橄榄丝针部位发生应力性骨折，1例需要髓内钉固定。术后，影像学前轴矫正至3.12±9.42度，侧轴矫正至10.42±11.86度。
患有多种合并症且使严重夏科氏足畸形复杂化的病态肥胖糖尿病患者，在对畸形进行手术矫正并使用中立应用的环形外固定器维持矫正后，可实现中足畸形的矫正。
