Hockenbury R Todd, Gruttadauria Michael, McKinney Ivan
University of Louisville, Advanced Orthopaedics of Louisville, Louisville, KY 40207, USA.
Foot Ankle Int. 2007 Sep;28(9):971-6. doi: 10.3113/FAI.2007.0971.
The purpose of this study was to review the results of arthrodesis of the Charcot hindfoot when an implantable bone growth stimulator was added to the procedure. Arthrodesis of the Charcot hindfoot has a high nonunion and complication rate.
Ten patients (ages 50 to 69 years) with Charcot neuroarthropathy of the ankle, hindfoot, or both had arthrodesis with use of rigid internal fixation and an implantable bone growth stimulator. There were six tibiotalocalcaneal, two pantalar, and two tibiocalcaneal arthrodeses. An intramedullary nail was used in nine patients and a blade plate was used in one patient. All but one patient was diabetic. Four of the ten patients had preoperative osteomyelitis or postoperative infection. Another patient had purulent drainage, although cultures were negative. Four patients had a preoperative ulceration. Five patients had a two-stage procedure for debridement of infected bone, removal of hardware, and placement of antibiotic beads. Autogenous bone graft from the distal fibula or proximal tibia was used in all patients.
One patient with a preoperative osteomyelitis developed a stable ankle pseudarthrosis. The other nine patients fused at an average of 3.7 months after surgery for a fusion rate of 90%. There were two major complications and eight minor complications. There were no amputations. All patients were ambulatory in a double upright brace or shoes for diabetic patients and were free of ulceration at the time of followup. Average American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score improved from 21 preoperatively to 59 postoperatively.
The adjunctive use of an implantable bone growth stimulator in conjunction with rigid internal fixation, autogenous bone grafting, and sound operative technique may enhance the outcome and fusion rate in patients undergoing arthrodesis for Charcot neuroarthropathy of the ankle and hindfoot.
本研究的目的是回顾在夏科氏后足关节融合手术中添加可植入式骨生长刺激器的结果。夏科氏后足关节融合术的骨不连和并发症发生率较高。
10例（年龄50至69岁）踝关节、后足或两者均患有夏科氏神经关节病的患者接受了使用坚强内固定和可植入式骨生长刺激器的关节融合术。其中有6例胫距跟关节融合术、2例全距关节融合术和2例胫跟关节融合术。9例患者使用了髓内钉，1例患者使用了刀片钢板。除1例患者外，其余均为糖尿病患者。10例患者中有4例术前患有骨髓炎或术后发生感染。另1例患者有脓性引流，尽管培养结果为阴性。4例患者术前有溃疡。5例患者接受了两阶段手术，包括清创感染骨、取出内固定物和放置抗生素珠。所有患者均使用了取自腓骨远端或胫骨近端的自体骨移植。
1例术前患有骨髓炎的患者出现了稳定的踝关节假关节。其他9例患者平均在术后3.7个月融合，融合率为90%。有2例主要并发症和8例次要并发症。无截肢病例。所有患者均使用双直立支具或糖尿病患者专用鞋行走，随访时无溃疡。美国矫形足踝协会（AOFAS）踝关节-后足平均评分从术前的21分提高到术后的59分。
在踝关节和后足夏科氏神经关节病的关节融合手术中，辅助使用可植入式骨生长刺激器联合坚强内固定、自体骨移植和良好的手术技术，可能会改善患者的预后并提高融合率。
