1 Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC, USA.
2 OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA.
Foot Ankle Int. 2019 Jan;40(1):18-23. doi: 10.1177/1071100718799966. Epub 2018 Oct 4.
: The purpose of this study was to examine the clinical outcomes and complications of patients with midfoot Charcot managed with midfoot osteotomy, realignment arthrodesis, and stabilization using intramedullary beams.
: Consecutive patients with midfoot Charcot treated at a tertiary-care foot and ankle center from January 2013 to July 2016 who underwent corrective osteotomy with internal beam fixation were identified; 25 patients were included in the final analysis. Patients with a minimum 1-year follow-up were evaluated with physical examination, weightbearing radiographs, and patient-reported outcome measures. The primary outcome measure was defined as restoration of a stable, plantigrade, ulcer-free foot. Median age was 58 years, median BMI was 32, and 80% were diabetic (75% insulin-dependent).
: An ulcer-free, stable, plantigrade foot was obtained in 84% of patients. The radiographic lateral and anteroposterior Meary angle medians improved 9° and 15°, respectively, from preoperative to final postoperative weightbearing measurements ( P < .001 and P = .02). Overall, 46% of midfoot osteotomies were united on final radiographs at a median 18-month radiographic follow-up. Deep infection developed in 6 (24%) patients. The presence of a preoperative ulcer was found to be predictive of postoperative infection (P = .04); all 6 deep infections occurred in patients with preoperative ulceration. Four (16%) patients progressed to amputation at a mean 15 postoperative months, all for deep infection.
: Midfoot Charcot reconstruction with intramedullary beaming allowed for restoration of an ulcer-free, plantigrade foot in most patients, but the complication rates were high, especially in patients with preoperative ulceration.
: Level IV, retrospective case series.
本研究旨在探讨采用跖骨切开复位内固定术治疗跖骨 Ch arcot 病的临床疗效及并发症。
回顾性分析 2013 年 1 月至 2016 年 7 月在我院足踝外科中心接受矫正性截骨术和髓内固定的中足 Ch arcot 患者，共纳入 25 例患者，平均随访 1 年以上，采用体格检查、负重位 X 线片和患者报告的结局测量进行评估。主要结局指标定义为获得稳定、负重、无溃疡的足部。患者平均年龄 58 岁，平均 BMI 为 32，80%为糖尿病（75%为胰岛素依赖型）。
84%的患者获得无溃疡、稳定、负重的足部。与术前相比，术后负重位 X 线片上的外侧和前后 Meary 角中位数分别改善了 9°和 15°（P<0.001 和 P=0.02）。总的来说，46%的中足截骨在最终随访时（平均 18 个月）X 线片上愈合。6 例（24%）患者发生深部感染。术前溃疡的存在与术后感染相关（P=0.04）；所有 6 例深部感染均发生在术前有溃疡的患者中。4 例（16%）患者因深部感染在术后 15 个月平均行截肢术。
采用髓内固定治疗中足 Ch arcot 病可使大多数患者获得无溃疡、负重的足部，但并发症发生率较高，尤其是在术前有溃疡的患者。
IV 级，回顾性病例系列。
