Molines-Barroso Raúl Juan, Lázaro-Martínez José Luis, Beneit-Montesinos Juan Vicente, Álvaro-Afonso Francisco Javier, García-Morales Esther, García-Álvarez Yolanda
1 Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Int J Low Extrem Wounds. 2019 Jun;18(2):129-134. doi: 10.1177/1534734619848553. Epub 2019 May 21.
Although exostectomy for chronic midfoot plantar ulcers in Charcot foot is apparently effective, with healing rates of nearly 75%, a subset of patients develop recurrent ulceration and show an unstable foot position, especially after undergoing exostectomy confined to the lateral column. The reasons for this failure have not been investigated. The main objective of this study was to evaluate the early changes in radiographic alignment after an exostectomy in patients with Charcot neuropathic osteoarthropathy (rocker bottom) and plantar ulcer located in the lateral column. The present study evaluated retrospectively changes in radiographic alignment after an exostectomy in 12 Charcot feet (rocker bottom) with plantar ulcer located in the lateral column. Indication for plantar exostectomy was the treatment of ulcer affected by osteomyelitis. We evaluated the early changes in the alignment of the foot on weight-bearing lateral radiographs 6 months after exostectomy. Paired sample Wilcoxon test was used to calculate the differences between preoperative and postoperative measurements. Furthermore, the relationship between revision surgery and early changes in radiographic angular measurements was determined by using the Mann-Whitney test. After exostectomy, the inclination of the calcaneal bone decreased ( = .003; = 0.849) and declination of talus bone increased ( = .041; = 0.589). The change in calcaneal inclination was associated with revision surgery ( = .042; = 0.586). The present case series demonstrates that exostectomy procedure for the lateral column in patients with Charcot foot results in radiological changes in the hindfoot over the sagittal plane. The inversion of the calcaneal pitch angle suggests the possibility of further adverse events and the need for revision surgery.
尽管针对夏科氏足慢性中足跖侧溃疡进行的外生骨切除术显然有效，愈合率近75%，但仍有一部分患者出现复发性溃疡，且足部位置不稳定，尤其是在接受局限于外侧柱的外生骨切除术后。这种失败的原因尚未得到研究。本研究的主要目的是评估夏科氏神经病变性骨关节炎（摇椅底足）且跖侧溃疡位于外侧柱的患者在外生骨切除术后影像学对线的早期变化。本研究回顾性评估了12例患有位于外侧柱的跖侧溃疡的夏科氏足（摇椅底足）在外生骨切除术后影像学对线的变化。跖侧外生骨切除术的指征是治疗受骨髓炎影响的溃疡。我们在外生骨切除术后6个月评估了负重侧位X线片上足部对线的早期变化。采用配对样本Wilcoxon检验计算术前和术后测量值之间的差异。此外，使用Mann-Whitney检验确定翻修手术与影像学角度测量早期变化之间的关系。外生骨切除术后，跟骨倾斜度降低（P = .003；r = 0.849），距骨倾斜度增加（P = .041；r = 0.589）。跟骨倾斜度的变化与翻修手术相关（P = .042；r = 0.586）。本病例系列表明，夏科氏足患者外侧柱的外生骨切除手术会导致后足在矢状面上的放射学变化。跟骨倾斜角的反转提示可能发生进一步不良事件以及需要进行翻修手术。
