Kriegelstein S, Volkering C, Altenberger S, Kessler S, Walther M
Schön Klinik München Harlaching, Zentrum für Fuß- und Sprunggelenkchirurgie München, Harlachinger Str. 51, 81547, München, Deutschland,
Oper Orthop Traumatol. 2015 Apr;27(2):129-38. doi: 10.1007/s00064-014-0337-9. Epub 2015 Apr 10.
Combination of external and internal fixation for improvement of stabilization in midfoot arthrodesis.
Charcot foot of the midfoot with/without (infection-free) ulceration.
Severe anesthesiological risks in multimorbid patients; untreated symptomatic peripheral arterial occlusive disease; severe soft tissue infection and defect with the necessity of amputation.
Performing subtractive resection arthrodesis of the midfoot with locking plates and screws combined with an external ring fixator of the foot and lower leg.
Postoperative partial weight bearing with sole contact and walking frame for 3 months. Then removal of external fixator, CT scan and based on the result, staged increasing of stress load with short-leg cast over a period of 4-6 weeks. Podomechanotherapy with full weight bearing.
With this surgical procedure, sufficient stabilization with fully load bearing, plantigrade foot with podomechanotherapy with the help of a combined internal and external fixation is possible. Complications (pin-tract infection or dislocation) exist, but they can be controlled. High healing rate of ulceration was achieved by bony position correction and stabilization.
采用内固定与外固定相结合的方法，提高中足关节融合术的稳定性。
伴有或不伴有（无感染）溃疡的中足夏科氏足。
患有多种疾病的患者存在严重麻醉风险；未经治疗的有症状的外周动脉闭塞性疾病；严重软组织感染及缺损且有截肢必要。
采用锁定钢板和螺钉对中足进行减法切除关节融合术，并结合足部和小腿的外固定架。
术后采用足底接触和步行架部分负重3个月。然后拆除外固定架，进行CT扫描，根据结果在4至6周内分阶段增加短腿石膏的应力负荷。进行全负重的足部力学治疗。
通过这种手术方法，借助内固定与外固定相结合，在全负重情况下实现足够的稳定性，足部力学治疗时足部呈跖行。存在并发症（针道感染或脱位），但可以控制。通过矫正和稳定骨位，溃疡愈合率较高。
