Vasukutty N, Jawalkar H, Anugraha A, Chekuri R, Ahluwalia R, Kavarthapu V
Diabetic Foot Unit, Kings College Hospital NHS Foundation Trust, United Kingdom.
Diabetic Foot Unit, Kings College Hospital NHS Foundation Trust, United Kingdom.
Foot Ankle Surg. 2018 Oct;24(5):406-410. doi: 10.1016/j.fas.2017.04.014. Epub 2017 Apr 28.
Corrective fusion for the unstable deformed hind foot and mid foot in Charcot Neuroarthropathy (CN) is quite challenging and is best done in tertiary centres under the supervision of multidisciplinary teams.
We present a follow up to our initial report with a series of 42 hind foot corrections in 40 patients from a tertiary level teaching hospital in the United Kingdom. The mean patient age was 59 (33-82). 17 patients had type1diabetes mellitus, 23 had type 2. 23 feet in 22 patients had chronic ulceration despite offloading. 17 patients were ASA 2 and 23 were ASA grade 3. All patients had hind foot nail fusion performed through a standard technique by the senior author and managed perioperatively by the multidisciplinary team.
At a mean follow up of 42 months (12-99) we achieved 100% limb salvage initially and a 97% fusion rate. One patient with persisting non-union of ankle and subtalar joint with difficulty in bracing has been offered below-knee amputation. We achieved deformity correction in 100% and ulcer healing in 83%. 83% patients are able to mobilize and manage independent activities of daily living. There were 11 patients with one or more complications including metal work failure, infection and ulcer reactivation. There have been nine repeat procedures including one revision fixation and one vascular procedure.
Single stage corrective fusion for hind foot deformity in CN is an effective procedure when delivered by a skilled multidisciplinary team.
夏科氏神经关节病（CN）中不稳定变形的后足和中足的矫正融合颇具挑战性，最好在三级中心由多学科团队监督下进行。
我们对来自英国一家三级教学医院的40例患者进行的42例后足矫正的初步报告进行了随访。患者平均年龄为59岁（33 - 82岁）。17例患者患有1型糖尿病，23例患有2型糖尿病。22例患者的23只脚尽管进行了减负处理仍有慢性溃疡。17例患者美国麻醉医师协会（ASA）分级为2级，23例为3级。所有患者均由资深作者通过标准技术进行后足钉融合，并由多学科团队进行围手术期管理。
平均随访42个月（12 - 99个月），我们最初实现了100%的肢体保全率和97%的融合率。一名踝关节和距下关节持续不愈合且支具佩戴困难的患者已接受膝下截肢。我们实现了100%的畸形矫正和83%的溃疡愈合。83%的患者能够活动并自理日常生活。有11例患者出现一种或多种并发症，包括金属植入物失效、感染和溃疡复发。有9例进行了再次手术，包括1例翻修固定和1例血管手术。
由经验丰富的多学科团队实施的CN后足畸形单阶段矫正融合术是一种有效的手术方法。
