Rettedal David, Parker Alissa, Popchak Adam, Burns Patrick R
Foot and Ankle Surgeon, CNOS, PC, Dakota Dunes, SD.
Foot and Ankle Surgeon, Washington Foot and Ankle Specialists, Washington, PA; Faculty, Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Foot Ankle Surg. 2018 May-Jun;57(3):451-455. doi: 10.1053/j.jfas.2017.10.021. Epub 2018 Mar 21.
Charcot neuroarthropathy is a destructive process that occurs in patients with peripheral neuropathy, often due to poorly controlled diabetes mellitus. Surgical reconstruction can be necessary to provide a plantigrade foot that is wound free. A risk of major amputation exists after a Charcot event and after attempted reconstruction. We retrospectively reviewed the data from 34 patients (36 reconstructions) who had undergone reconstructive surgery for Charcot neuroarthropathy. The mean patient age was 56.44 years. The mean follow-up period was 56 months. We collected patient age, body mass index, presence of wound or osteomyelitis, anatomic location, activity of disease, and hemoglobin A1c. Using these data, each patient was given a score using our novel prognostic scoring system, the Charcot Reconstruction Preoperative Prognostic Score (CRPPS). Our primary outcome measure was no wound and no major amputation at the final follow-up visit. The limb salvage rate was 89% (32 of 36), and 78% (28 of 36) had no wound at the final follow-up examination. For patients without a wound or major amputation at the final follow-up visit, the mean CRPPS was 2.96 ± 1.23. The mean CRPPS for those with a wound or major amputation at the final follow-up visit was 4.33 ± 1.07 (p = .0024). Univariate logistic regression revealed 2 statistically significant predictors of wound and/or amputation: anatomic location (odds ratio [OR] 5.0, 95% confidence interval [CI] 1.051 to 23.789; p = .043) and CRPPS (OR 2.724, 95% CI 1.274 to 5.823, p = .01). A CRPPS of ≥4 was also predictive of a negative outcome (OR 7.286, 95% CI 1.508 to 35.211; p = .013). This scoring system, with a sensitivity of 75%, specificity of 71%, and negative predictive value of 85%, is a potential starting point when educating patients and making treatment decisions in this exceptionally challenging group.
夏科氏关节病是一种发生在外周神经病变患者中的破坏性病变，通常由控制不佳的糖尿病引起。手术重建对于获得无伤口的跖行足可能是必要的。在夏科氏病变发作后以及尝试进行重建手术后，存在大截肢的风险。我们回顾性分析了34例（36次重建手术）接受夏科氏关节病重建手术患者的数据。患者平均年龄为56.44岁。平均随访期为56个月。我们收集了患者年龄、体重指数、伤口或骨髓炎的存在情况、解剖位置、疾病活动度以及糖化血红蛋白。利用这些数据，我们使用我们新的预后评分系统——夏科氏重建术前预后评分（CRPPS）对每位患者进行评分。我们的主要结局指标是在最后一次随访时无伤口且无大截肢。肢体挽救率为89%（36例中的32例），在最后一次随访检查时，78%（36例中的28例）无伤口。对于在最后一次随访时无伤口或大截肢的患者，平均CRPPS为2.96±1.23。在最后一次随访时有伤口或大截肢的患者，平均CRPPS为4.33±1.07（p = 0.0024）。单因素逻辑回归显示，伤口和/或截肢的2个具有统计学意义的预测因素：解剖位置（比值比[OR]5.0，95%置信区间[CI]1.051至23.789；p = 0.043）和CRPPS（OR 2.724，95%CI 1.274至5.823，p = 0.01）。CRPPS≥4也可预测不良结局（OR 7.286，95%CI 1.508至35.211；p = 0.013）。这个评分系统的敏感性为75%，特异性为71%，阴性预测值为85%，在对这个极具挑战性的患者群体进行教育和做出治疗决策时，可能是一个潜在的起点。
