ElAlfy Barakat, Ali Ayman M, Fawzy Sallam I
Assistant Professor, Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Assistant Professor, Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
J Foot Ankle Surg. 2017 Mar-Apr;56(2):309-313. doi: 10.1053/j.jfas.2016.10.014.
Charcot neuroarthropathy of the ankle joint is a destructive process that leads to instability and significant morbidity that can end with amputation. Surgical arthrodesis in Charcot neuroarthropathy has a high failure rate. The aim of the present prospective study was to compare the outcomes of an Ilizarov external fixator and retrograde intramedullary nailing (IMN) for tibiotalar arthrodesis in Charcot neuroarthropathy. From February 2010 to October 2013, 27 patients (16 males and 11 females) with Charcot neuropathy of the ankle joint were treated in our department. Their ages ranged from 32 to 75 (average 54) years. Of the 27 patients, 14 received an Ilizarov external fixator and 13 underwent IMN. A preoperative clinical and radiologic assessment of all patients was performed. The outcomes were measured for bone union, development of complications, and clinical follow-up. The mean score of modified American Orthopaedic Foot and Ankle Society ankle hindfoot scale was 80 ± 2.7 points in the Ilizarov group and 75 ± 1.9 points in the IMN group. In the Ilizarov group, 12 of 14 patients achieved union, and in the IMN group, 10 of 13 patients achieved union. The complication rate was significantly greater in the external fixator group than in the IMN group. The complications in the Ilizarov group included nonunion in 2 patients (14%), pin tract infection in 8 (57%), pin tract loosening in 3 (21%), surgical wound infection in 3 (21%), and wound breakdown in 1 patient (7%). In the IMN group, nonunion occurred in 3 patients (23.1%), back-out of a distal locking bolt in 2 (15.4 %), and a superficial wound infection that resolved with antibiotics in 1 patient (7.7%). In conclusion, retrograde IMN and the Ilizarov external fixator both yielded better union for tibiotalar arthrodesis in Charcot neuroarthropathy. The Ilizarov external fixator resulted in a greater union rate than IMN but the complications with external fixation were significantly greater than those with IMN.
踝关节夏科氏神经关节病是一种破坏性病变，可导致关节不稳和严重致残，最终可能需要截肢。夏科氏神经关节病的手术关节融合术失败率很高。本前瞻性研究的目的是比较伊里扎洛夫外固定器和逆行髓内钉固定术（IMN）治疗夏科氏神经关节病胫距关节融合术的疗效。2010年2月至2013年10月，我科共治疗27例踝关节夏科氏神经病变患者（男16例，女11例）。年龄范围为32至75岁（平均54岁）。27例患者中，14例采用伊里扎洛夫外固定器治疗，13例行IMN手术。对所有患者进行了术前临床和影像学评估。对骨愈合、并发症发生情况及临床随访结果进行了测量。伊里扎洛夫组改良美国矫形足踝协会踝后足评分平均为80±2.7分，IMN组为75±1.9分。伊里扎洛夫组14例患者中有12例实现骨愈合，IMN组13例患者中有10例实现骨愈合。外固定器组的并发症发生率显著高于IMN组。伊里扎洛夫组的并发症包括2例骨不连（14%）、8例针道感染（57%）、针道松动3例（21%）、手术伤口感染3例（21%）、1例伤口裂开（7%）。IMN组有3例骨不连（23.1%）、2例远端锁定螺栓退出（15.4%）、1例浅表伤口感染经抗生素治疗后痊愈（7.7%）。总之，逆行IMN和伊里扎洛夫外固定器在夏科氏神经关节病胫距关节融合术中均能取得较好的骨愈合效果。伊里扎洛夫外固定器的骨愈合率高于IMN，但外固定的并发症明显多于IMN。
