Yammine Kaissar, Assi Chahine
1 Department of Orthopedics, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon.
2 School of Medicine, Lebanese American University, Byblos, Lebanon.
J Orthop Surg (Hong Kong). 2019 May-Aug;27(2):2309499019836012. doi: 10.1177/2309499019836012.
Ankle Charcot neuroarthropathy presents a great challenge for treatment. While conservative treatments yield poor results, arthrodesis is considered the treatment of choice for unstable Charcot ankles. There are two methods used for ankle fusion: retrograde intramedullary nail (IMN) and external fixator (EF). Literature reports inconclusive results on which method is better for arthrodesis.
The aim of this meta-analysis is to look for significant difference between the two techniques in terms of fusion rate and complications. Four comparative studies including 117 patients (117 interventions) were located and analyzed.
IMN was found to yield double fusion rate than EF ( p = 0.2) with 5 weeks less time to heal ( p = 0.4). While no significance was noted for revision surgery and amputation rates, EF yielded higher rates of hardware infection ( p = 0.01) and wound infection ( p = 0.01). The IMN method seems to offer quicker and better fusion rate when compared to EF with significantly lower postoperative infection rates.
In the clinical context of high-risk patients such as the diabetic population, IMN technique could be a better option in the case of ulcer-free ankles/feet or in the presence of medial/lateral ulcers. In case of presence of plantar ulcers, EF might be a better choice to avoid the plantar approach for nail insertion. Future research with bigger sample sized and randomized studies are warranted for validation.
踝关节夏科氏神经关节病的治疗极具挑战性。尽管保守治疗效果不佳，但关节融合术被认为是不稳定型夏科氏踝关节的首选治疗方法。踝关节融合术有两种方法：逆行髓内钉（IMN）和外固定架（EF）。关于哪种方法更适合关节融合术，文献报道的结果尚无定论。
本荟萃分析的目的是寻找这两种技术在融合率和并发症方面的显著差异。检索并分析了四项比较研究，共纳入117例患者（117次干预）。
发现IMN的融合率是EF的两倍（p = 0.2），愈合时间缩短5周（p = 0.4）。虽然翻修手术率和截肢率无显著差异，但EF的硬件感染率（p = 0.01）和伤口感染率（p = 0.01）更高。与EF相比，IMN方法似乎能提供更快、更好的融合率，且术后感染率显著更低。
在糖尿病患者等高风险患者的临床情况下，对于无溃疡的踝关节/足部或存在内侧/外侧溃疡的情况，IMN技术可能是更好的选择。如果存在足底溃疡，EF可能是更好的选择，以避免经足底插入髓内钉。未来需要进行更大样本量的随机研究以验证。
