Service de Chirurgie Orthopédique et Traumatologiede l'Appareil Moteur, Hôpitaux Universitaires de Genève, 24 rue Micheli-du-Crest, Genève 14, Switzerland.
J Bone Joint Surg Am. 2010 Mar;92 Suppl 1 Pt 1:20-31. doi: 10.2106/JBJS.I.01288.
The failure of nonsurgical treatment of patients with midfoot and hindfoot deformity secondary to diabetic Charcot arthropathy may lead to a rocker-bottom foot deformity with recurrent or persistent plantar ulceration. We report our experience with realignment and extended fusion with primary use of a medial column screw for this midfoot deformity.
From July 2001 through July 2005, we performed reconstructive surgery on fifteen adults with diabetes mellitus who had a severe neuropathic midfoot deformity consisting of a collapsed plantar arch with a rocker-bottom foot deformity. Thirteen had a nonhealing midfoot plantar ulcer. All underwent realignment and arthrodesis with a medial column screw; some required additional fixation techniques depending on the extent of the deformity. Outcome measures included ulcer and surgical wound-healing, radiographic results, complications, and the need for amputation.
The mean duration of clinical follow-up was forty-two months. Fourteen patients were able to walk, and there were no recurrent plantar ulcers. Thirteen patients were able to wear custom-made extra-depth, wide-toed shoes with molded inserts. One patient without prior ulceration had development of a deep infection that necessitated an amputation. Four feet had a nonunion, one of which was symptomatic requiring a revision to obtain union.
Surgical reconstruction of a collapsed neuropathic foot deformity is technically demanding, but a successful outcome can result in a plantigrade foot that is free of ulceration and abnormal pressure points and a patient who is able to walk. The procedure described has an acceptable degree of complications although it has a high rate of nonunion.
糖尿病性夏科氏关节病引起的中足和后足畸形的非手术治疗失败，可能导致具有复发性或持续性足底溃疡的摇椅底足畸形。我们报告我们使用内侧柱螺钉对这种中足畸形进行重新排列和扩展融合的经验。
从 2001 年 7 月至 2005 年 7 月，我们对 15 例患有严重神经病变性中足畸形的成年糖尿病患者进行了重建手术，该畸形包括具有摇椅底足畸形的塌陷足底弓。13 例有未愈合的中足足底溃疡。所有患者均接受内侧柱螺钉的重新排列和融合；根据畸形的程度，一些患者需要额外的固定技术。结果测量包括溃疡和手术伤口愈合、影像学结果、并发症以及截肢的需要。
临床随访平均时间为 42 个月。14 例患者能够行走，且无足底溃疡复发。13 例患者能够穿着定制的特大号、宽趾、模制插入物的鞋子。1 例无既往溃疡的患者发生深部感染，需要截肢。4 例足部发生骨不连，其中 1 例因需要重新融合以获得融合而出现症状。
塌陷性神经病变性足畸形的手术重建技术要求很高，但成功的结果可以导致足底无溃疡和异常压力点且能够行走的平足。尽管该手术具有较高的不愈合率，但所描述的手术方法并发症发生率可以接受。
