Dalla Paola Luca, Volpe Antonio, Varotto Davide, Postorino Andrea, Brocco Enrico, Senesi Antonella, Merico Maurizio, De Vido Daniele, Da Ros Roberto, Assaloni Roberta
Abano Terme Hospital, Diabetic Foot Department, Piazza Cristoforo Columbo 1, Abano Terme, Padova 35031, Italy.
Foot Ankle Int. 2007 Sep;28(9):967-70. doi: 10.3113/FAI.2007.0967.
Charcot neuroarthropathy is a serious complication associated with diabetic neuropathy. This complication probably is most serious when the ankle is involved because of the instability and progressive deformity, which often leads to ulceration, osteomyelitis, and amputation. Arthrodesis before the ulcerated lesion appears is considered a limb salvage treatment. One of the most effective techniques for an unstable ankle in Charcot neuroarthropathy is retrograde transcalcaneal nailing.
Eighteen diabetic patients, without a history of ulceration, were treated from July, 2003, to November, 2005, with panarthrodesis of the ankle using intramedullary retrograde transcalcaneal nailing. The average follow up was 14 +/- 10.1 months. All patients completed the unloaded postoperative period with a fiberglass cast (3 months nonweightbearing and 3 months partial weightbearing) and commenced walking in shoes with a stiff rocker sole and a molded insole.
During the followup period there were no major complications. In three patients, removal of one of the proximal screws used for anchoring the nail to the tibia was done because of protrusion causing skin breakdown. Fourteen patients had a stable fusion and four patients had fibrous union. The percentage of limb salvage was 100% in the followup period.
Our study confirms that this operative technique is effective and safe.
夏科氏神经关节病是糖尿病神经病变相关的一种严重并发症。当累及踝关节时，这种并发症可能最为严重，因为踝关节不稳定且畸形不断进展，常导致溃疡、骨髓炎及截肢。在溃疡病变出现前进行关节融合术被认为是一种肢体挽救治疗方法。对于夏科氏神经关节病中不稳定的踝关节，最有效的技术之一是逆行跟骨髓内钉固定术。
2003年7月至2005年11月，对18例无溃疡病史的糖尿病患者采用逆行跟骨髓内钉固定术进行踝关节全关节融合术治疗。平均随访时间为14±10.1个月。所有患者术后均使用玻璃纤维石膏完成非负重期（3个月非负重及3个月部分负重），并开始穿着带有硬摇椅鞋底和模制鞋垫的鞋子行走。
随访期间无重大并发症。3例患者因近端用于将髓内钉固定于胫骨的螺钉突出导致皮肤破损而取出其中一枚螺钉。14例患者获得稳定融合，4例患者为纤维性骨愈合。随访期间肢体挽救率为100%。
我们的研究证实该手术技术有效且安全。
