Ettinger Sarah, Plaass Christian, Claassen Leif, Stukenborg-Colsman Christina, Yao Daiwei, Daniilidis Kiriakos
Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany.
Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany.
J Foot Ankle Surg. 2016 May-Jun;55(3):522-8. doi: 10.1053/j.jfas.2015.12.008. Epub 2016 Feb 19.
Charcot neuropathy (CN) is a severe joint disease that makes surgical planning very challenging, because it is combined with ankle instability, serious deformities, and recurrent ulceration. The aim of the present study was to examine the rate of bone fusion after external or internal fixation in patients with CN. We retrospectively examined 58 patients with CN who had undergone reconstruction of the ankle either with tibiotalocalcaneal or tibiocalcaneal arthrodesis. The mean age was 59.1 (range 26 to 81) years at surgery. Of the 58 patients, 38 were treated using intramedullary nail arthrodesis and 19 using an external fixator (1 patient received neither). At a mean follow-up period of 31.3 (range 12 to 57) months, limb salvage and bone fusion had been achieved in 94.83%. The mean time to bone fusion was 12 (range 6 to 18) months. Three patients (5.2%) required a more proximal amputation. All but these 3 patients gained independent mobilization in custom feet orthoses or off the shelf orthoses. Of the 58 patients in the present cohort, 56 (96.6%) would undergo surgery again. In conclusion, internal and external fixation both lead to promising results in the treatment of CN. Internal fixation should be preferred when no indications of ulcer or infection are present.
夏科氏神经病变（CN）是一种严重的关节疾病，这使得手术规划极具挑战性，因为它伴有踝关节不稳、严重畸形和反复溃疡。本研究的目的是检查CN患者进行外固定或内固定后骨融合的发生率。我们回顾性研究了58例接受胫距跟或胫跟关节融合术重建踝关节的CN患者。手术时的平均年龄为59.1岁（范围26至81岁）。58例患者中，38例采用髓内钉关节融合术治疗，19例采用外固定器治疗（1例未接受任何治疗）。平均随访期为31.3个月（范围12至57个月），保肢和骨融合率达到94.83%。骨融合的平均时间为12个月（范围6至18个月）。3例患者（5.2%）需要进行更近端的截肢。除这3例患者外，所有患者均通过定制足部矫形器或现成的矫形器实现了独立活动。在本队列的58例患者中，56例（96.6%）愿意再次接受手术。总之，内固定和外固定在CN治疗中均取得了良好的效果。在没有溃疡或感染迹象时，应优先选择内固定。
