Wukich Dane K, Shen James Y C, Ramirez Claudia P, Irrgang James J
Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15203, USA.
J Foot Ankle Surg. 2011 May-Jun;50(3):299-306. doi: 10.1053/j.jfas.2010.12.028. Epub 2011 Mar 9.
Tibiotalocalcaneal arthrodesis (TTCA) has been used for the salvage of severe deformity involving the ankle and hindfoot. The purpose of this study was to evaluate the results of retrograde intramedullary nailing (IMN) for severe ankle/hindfoot pathology in a group of patients with diabetic neuropathy and compare them with a cohort of nondiabetic patients. Our working hypothesis was that patients with diabetes mellitus (DM) and neuropathy would experience inferior outcomes and more postoperative complications than patients who did not have DM. Forty consecutive patients (17 with DM and 23 without DM) who had a minimum follow-up of 1 year were retrospectively reviewed. The mean follow-up was 33 months and the mean AOFAS Ankle Hindfoot Score significantly improved form 19 to 55. Patients with DM improved on average from 24 to 55 and patients without DM improved from 16 to 55. Although a postoperative complication was experienced in 59% of patients with DM compared with 44% of patients without DM, this difference did not reach statistical significance with the numbers available. More patients with DM used a brace at final follow-up than patients without DM. Those patients who had a history of preoperative skin ulceration had higher rates of infection than those patients who did not have skin ulcers. We did not find any significant postoperative differences in AOFAS Ankle Hindfoot Scores between those patients with DM versus patients without DM. On average, patients with DM demonstrated an improvement of 129% and patients without diabetes improved by 243%. With the numbers available, we were not able to confirm our hypothesis that patients with DM experienced significantly lower clinical outcomes than patients without DM. A study of 100 patients in each group would be necessary to achieve adequate power to conclusively state that DM had no impact on the final outcome.
胫距跟关节融合术（TTCA）已被用于挽救涉及踝关节和后足的严重畸形。本研究的目的是评估逆行髓内钉固定术（IMN）治疗一组糖尿病性神经病变患者严重踝关节/后足病变的结果，并将其与非糖尿病患者队列进行比较。我们的工作假设是，糖尿病（DM）和神经病变患者的预后会比没有DM的患者差，术后并发症更多。对40例连续患者（17例患有DM，23例没有DM）进行回顾性研究，这些患者的最短随访时间为1年。平均随访时间为33个月，平均美国足踝外科协会（AOFAS）踝关节后足评分从19分显著提高到55分。患有DM的患者平均从24分提高到55分，没有DM的患者从16分提高到55分。虽然59%的DM患者有术后并发症，而没有DM的患者为44%，但就现有数据而言，这种差异未达到统计学意义。在最终随访时，使用支具的DM患者比没有DM的患者更多。有术前皮肤溃疡病史的患者感染率高于没有皮肤溃疡的患者。我们没有发现DM患者与非DM患者之间在AOFAS踝关节后足评分上有任何显著的术后差异。平均而言，DM患者改善了129%，非糖尿病患者改善了243%。就现有数据而言，我们无法证实我们的假设，即DM患者的临床结局明显低于没有DM的患者。每组研究100例患者才有足够的效力来最终确定DM对最终结局没有影响。
