Kim J-Young, Kim Tae Wan, Park Young Eun, Lee Yoon Jung
Department of Orthopedic Surgery, Eulji University Hospital, Seoul, South Korea.
Foot Ankle Int. 2008 May;29(5):493-7. doi: 10.3113/FAI-2008-0493.
Diabetic motor neuropathy is expressed as the loss of function and the contracture of the intrinsic muscles of the foot, leading to the classic claw toe deformity. This deformity predisposes the foot to ulcerations on the dorsum or tip of the toes or an interdigital ulcer over a condyle between the toes. We present our results of a modified resection arthroplasty for the treatment of this difficult problem.
In this study, 72 toes (57 feet) with a deformity in the second to fifth toe accompanied by chronically infected ulcers were involved. All patients underwent modified resection arthroplasty of the PIP or DIP joint depending on the ulcer location. The second toe was involved in 27 cases (38%), the third toe in 11 cases (15%), the fourth toe in 19 cases (26%), and the fifth toe in 15 cases (21%). With the exception of 4 patients, all had a positive culture, including 7 cases of MRSA. The mean followup was 28.7 +/- 8.1 months.
The mean wound healing time was 25.6 +/- 6.2 days. Three cases eventually required toe amputation but there was no proximal spread of infection. No recurrence of a claw toe or ulcer occurred in the remaining toes.
We believe that modified resection arthroplasty for toe deformities with chronic infected ulcers in diabetic patients is a good treatment alternative to toe amputation.
糖尿病性运动神经病变表现为足部内在肌功能丧失和挛缩，导致典型的爪形趾畸形。这种畸形使足部易在足背、趾尖或趾间髁处发生溃疡。我们展示了改良切除关节成形术治疗这一难题的结果。
本研究纳入72个趾（57只足），第二至第五趾存在畸形并伴有慢性感染性溃疡。根据溃疡位置，所有患者均接受了近端指间关节（PIP）或远端指间关节（DIP）的改良切除关节成形术。第二趾受累27例（38%），第三趾11例（15%），第四趾19例（26%），第五趾15例（21%）。除4例患者外，所有患者培养结果均为阳性，其中耐甲氧西林金黄色葡萄球菌（MRSA）感染7例。平均随访时间为28.7±8.1个月。
平均伤口愈合时间为25.6±6.2天。3例最终需要截趾，但感染无近端扩散。其余趾未出现爪形趾或溃疡复发。
我们认为，改良切除关节成形术治疗糖尿病患者伴有慢性感染性溃疡的趾畸形是替代截趾的一种良好治疗选择。
