Sundararajan Silvampatty R, Srikanth Kanchana P, Nagaraja Handenahally S, Rajasekaran Shanmuganathan
Consultant Orthopaedic and Arthroscopic Surgeon, Department of Orthopaedics, Ganga Hospital, Coimbatore.
Senior Registrar, Department of Orthopaedics, Ganga Hospital, Coimbatore, Tamil Nadu, India.
J Foot Ankle Surg. 2017 Mar-Apr;56(2):282-286. doi: 10.1053/j.jfas.2016.11.002. Epub 2017 Jan 16.
The optimal time to treat neuropathic (Charcot) arthropathy of the ankle and peritalar joint is controversial because of the various treatment options available and the variable results reported in published studies. We sought to determine the outcome of hind foot arthrodesis with stable internal fixation in patients with different Eichenholtz stages of arthropathy. We prospectively studied patients with substantial disabilities caused by neuropathic arthropathy in deformed, unstable ankle and peritalar joints, with or without ulcerations, who had undergone treatment from July 2007 to December 2012. All patients underwent ankle arthrodesis, autologous iliac crest bone grafting, and subtalar joint arthrodesis, with or without talonavicular joint arthrodesis, fixed internally with an intramedullary hindfoot nail, with or without an additional plate or cancellous screws. Of the 33 enrolled patients, 9 (27.3%) had stage I, 13 (39.4%) had stage II, and 11 (33.3%) had stage III Charcot arthropathy. The cause of arthropathy was diabetes mellitus in 25 (75.8%) patients. The duration of symptoms ranged from 1 to 120 (median 7) months. The mean follow-up period was 40 (range 12 to 76) months and did not differ markedly among the groups. The hindfoot scores, rate of salvage or amputation, or complication rates did not differ significantly across Eichenholtz stage. For the patients with stage I, II, and III, the preoperative hindfoot score was 50, 49, and 48, respectively (p = .9). The corresponding postoperative scores were 68, 68, and 70 (p = .5). We found no evidence that the effectiveness of hindfoot arthrodesis by stable fixation varied across the Eichenholtz stage of Charcot arthropathy involving ankle and peritalar joint. Furthermore, we found that stable internal fixation and bone grafting using a hindfoot nail results in an 84.84% union rate and salvages the unstable and disabled foot in 90.9% of patients with ankle and peritalar Charcot arthropathy.
由于可用的治疗方案多种多样，且已发表研究报告的结果各不相同，因此治疗踝关节和距周关节神经性（夏科氏）关节病的最佳时机存在争议。我们试图确定在患有不同艾兴霍尔茨（Eichenholtz）关节病分期的患者中，采用稳定内固定进行后足关节融合术的效果。我们对2007年7月至2012年12月期间接受治疗的、因神经性关节病导致严重残疾的患者进行了前瞻性研究，这些患者的踝关节和距周关节变形、不稳定，有或没有溃疡。所有患者均接受了踝关节融合术、自体髂嵴骨移植以及距下关节融合术，有或没有舟楔关节融合术，并用髓内后足钉进行内固定，有或没有附加钢板或松质骨螺钉。在33例入组患者中，9例（27.3%）为I期，13例（39.4%）为II期，11例（33.3%）为III期夏科氏关节病。25例（75.8%）患者的关节病病因是糖尿病。症状持续时间为1至120个月（中位值7个月）。平均随访期为40个月（范围12至76个月），各组之间无明显差异。后足评分、挽救或截肢率以及并发症发生率在艾兴霍尔茨分期之间无显著差异。对于I期、II期和III期患者，术前的后足评分别分为50分、49分和48分（p = 0.9）。相应的术后评分为68分、68分和70分（p = 0.5）。我们没有发现证据表明，在涉及踝关节和距周关节的夏科氏关节病的艾兴霍尔茨分期中，稳定固定的后足关节融合术的有效性存在差异。此外，我们发现使用后足钉进行稳定的内固定和骨移植，骨愈合率为84.84%，并且在90.9%的踝关节和距周关节夏科氏关节病患者中挽救了不稳定和残疾的足部。
