Oesman I, Asdi A R B
Consultant of Foot and Ankle Division, Staff of Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Jl. Diponegoro No. 71, Jakarta, 10430, Indonesia.
Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Jl. Diponegoro No. 71, Jakarta, 10430, Indonesia.
Int J Surg Case Rep. 2019;57:9-14. doi: 10.1016/j.ijscr.2019.02.035. Epub 2019 Mar 6.
Charcot osteoneuroarthopathy (CN) is a progressive degenerative arthropathy determined by the interaction of neuropathy, osteopaenia and proinflammatory cytokines. The aim of treatment is to maintain the foot on plantigrade position, recover foot deformity, osseous stability, and prevent ulceration. Intramedullary fixation in calcaneotalotibial arthrodesis has been described in promotion of rigid internal fixation with minimal soft tissue violation producing deformity correction, minimal periosteal aggression, vascular damaged and good functional outcome, with less postoperative fusion time and able to achieve fusion of the ankle and the subtalar joint after failed fusion.
Two patients with charcot foot underwent tibiocalcaneal arthrodesis with retrograde intramedullary technique by Expert Tibial Nail (ETN). The patients are both male 59 years with right ankle deformity 9 months prior to admission and history of trauma and 40 years old with history of Type 2 Diabetes Mellitus. Visual analog scale (VAS), AOFAS and SF score were assessed pre and post operative.
A good stability, plantigrade ankle and painless foot on both patients were achieved with a mean score 9 for satisfaction. Pre and 3 months post operative VAS were 4 and 1, AOFAS Scale were 58 and 83, mean of SF-36 were 28.4 and 48.6 for physical condition, 37.3 and 67.2. for mental condition consecutively. No severe postoperative complication were recorded CONCLUSION: Tibiotalocalcaneal arthrodesis with retrograde intramedullary technique using ETN system was proven to have a good option for ankle joint salvage with improvement of clinical and functional score. Hence, its application in the charcot joint is promising.
夏科特骨神经关节病（CN）是一种由神经病变、骨质减少和促炎细胞因子相互作用所决定的进行性退行性关节病。治疗目的是使足部保持跖行位，矫正足部畸形、恢复骨质稳定性并预防溃疡。跟骨-距骨-胫骨关节融合术中的髓内固定已被描述为可促进坚强内固定，软组织损伤最小，可实现畸形矫正、骨膜侵袭最小、血管损伤小且功能预后良好，术后融合时间较短，并且在融合失败后能够实现踝关节和距下关节的融合。
两名患有夏科特足的患者采用专家胫骨钉（ETN）逆行髓内技术进行了胫跟关节融合术。两名患者均为男性，一名59岁，入院前9个月出现右踝畸形且有外伤史；另一名40岁，有2型糖尿病史。术前和术后评估了视觉模拟量表（VAS）、美国足踝外科协会（AOFAS）评分和简明健康状况调查（SF）评分。
两名患者均获得了良好的稳定性、跖行位踝关节和无痛足部，满意度平均评分为9分。术前和术后3个月的VAS评分分别为4分和1分，AOFAS量表评分分别为58分和83分，SF-3�身体状况评分均值分别为28.4分和48.6分，精神状况评分均值分别为37.3分和67.2分。未记录到严重的术后并发症。结论：使用ETN系统的逆行髓内技术进行胫距跟关节融合术被证明是挽救踝关节的良好选择，可改善临床和功能评分。因此，其在夏科特关节中的应用前景广阔。
