Moore Jeffrey, Berberian Wayne S, Lee Manuel
Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
Department of Orthopaedics, Division of Foot and Ankle Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA Hackensack University Medical Center, Hackensack, NJ, USA.
Foot Ankle Int. 2015 May;36(5):547-55. doi: 10.1177/1071100714563309. Epub 2014 Dec 15.
In the setting of chronic osteomyelitis following fractures about the ankle, reconstruction through bony arthrodesis may be used as a reconstructive alternative to amputation. During these cases, surgeons often avoid using internal fixation in an attempt to avoid reinfection or premature hardware failure. In this retrospective review, we analyzed the outcomes of chronic osteomyelitic patients who had an arthrodesis of the ankle using either internal or external fixation, focusing on salvage rates, infection clearance, union rates, and functional outcomes. No device was implanted into a known active infection.
We performed a retrospective chart review of adult patients undergoing arthrodesis in the setting of a previously septic ankle following a traumatic injury. In each case, multiple irrigation and debridement procedures and local and systemic antibiotics were used. Infection status was determined by clinical exam, MRI, nuclear medicine studies, and ultimately bone biopsies. No fixation device was implanted in ankles with known active infections. Patients were divided into 2 cohorts: those fused with internal devices and those fused with external fixators. Thirty patients underwent a total of 32 arthrodesis procedures. Mean follow up time was 27 months (range, 6 to 144).
Nineteen fusions were performed using internal fixation; only 2 required amputations, therefore limb salvage was 90%. Fifteen were able to ambulate with or without the assistance of an orthosis (79%). Four patients experienced recurrent infection (21%) and 5 developed nonunion (26%). Of the 13 fusions performed with external fixators, only 1 required an amputation, putting limb salvage at 92%. Ten patients were able to walk with or without the assistance of an orthosis as their final functional status (77%). Two patients experienced recurrent infection (15%), and 4 went on to nonunion (31%).
When analyzing these 2 fusion methods in posttraumatic patients with previously septic ankles, with the numbers available both methods achieved similar rates of limb salvage and final functional status in these patients, as well as similar rates of infection clearance and bony union. As internal fixation is often less labor-intensive for the surgeon and more palatable for the patient postoperatively, we encourage surgeons to consider arthrodesis with internal fixation once the infection is successfully eradicated, especially in a noncompliant patient population.
Level III, retrospective comparative series.
在踝关节周围骨折后慢性骨髓炎的情况下，通过骨性关节融合术进行重建可作为截肢的一种重建替代方法。在这些病例中，外科医生通常避免使用内固定，以试图避免再次感染或内固定过早失效。在这项回顾性研究中，我们分析了采用内固定或外固定进行踝关节融合术的慢性骨髓炎患者的治疗结果，重点关注保肢率、感染清除率、骨愈合率和功能结果。未将任何器械植入已知的活动性感染部位。
我们对创伤后既往有感染性踝关节的成年患者进行关节融合术的病历进行了回顾性分析。在每个病例中，均采用了多次冲洗和清创手术以及局部和全身抗生素治疗。通过临床检查、磁共振成像（MRI）、核医学检查以及最终的骨活检来确定感染状态。未在已知有活动性感染的踝关节中植入固定器械。患者分为两组：采用内固定器械融合的患者和采用外固定架融合的患者。30例患者共接受了32次关节融合手术。平均随访时间为27个月（范围6至144个月）。
采用内固定进行了19次融合手术；仅2例需要截肢，因此保肢率为90%。15例患者能够在有或没有矫形器辅助的情况下行走（79%）。4例患者发生复发性感染（21%），5例出现骨不愈合（26%）。在采用外固定架进行的13次融合手术中，仅1例需要截肢，保肢率为92%。10例患者最终能够在有或没有矫形器辅助的情况下行走（77%）。2例患者发生复发性感染（15%），4例出现骨不愈合（31%）。
在分析这两种融合方法在既往有感染性踝关节的创伤后患者中的应用时，就现有数据而言，这两种方法在这些患者中实现了相似的保肢率和最终功能状态，以及相似的感染清除率和骨愈合率。由于内固定对外科医生来说通常劳动强度较小，且术后对患者来说更易接受，我们鼓励外科医生在感染成功根除后考虑采用内固定进行关节融合术，尤其是在依从性较差的患者群体中。
三级，回顾性比较系列研究。
