Resident, Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA.
Associate, Centers for Advanced Orthopaedics, Catonsville, MD.
J Foot Ankle Surg. 2020 Mar-Apr;59(2):431-435. doi: 10.1053/j.jfas.2018.11.036.
Retrograde intramedullary nails are often used for tibiotalocalcaneal arthrodesis to correct severe hindfoot deformities in high-risk patient populations. The purposes of the current study are to report outcomes of patients undergoing staged management of infection after intramedullary nail fixation for tibiotalocalcaneal arthrodesis and to review the surgical approach to management of this limb-threatening complication. The authors reviewed patients who underwent hindfoot intramedullary nailing with subsequent revision for infection between January 2006 and December 2016. Staged protocol with antibiotic nail for the management of deep infection was used in 19 patients. The mean follow-up was 115.87 ± 92.80 (range 2.29 to 341.86) weeks. Twelve of the patients had diabetes, 10 had Charcot neuroarthropathy, and 7 had arthrodesis for equinovarus deformity. Sixteen had peripheral neuropathy and 13 had history of ulceration on the operated extremity. Limb salvage with the use of this protocol was achieved in 14 (73.68%) of 19 patients. Five (26.32%) patients had proximal amputation with 3 (15.79%) deaths within the follow-up period. Amputation was more likely in the nonsmoking (p = .01) and insulin-dependent (odds ratio = 22, p = .02) patient cohorts, whereas death was associated only with higher body mass index (p = .03). Time to revision was greater in patients with external bracing postoperatively as well (p = .004). Outcomes, including total number of procedures and retained antibiotic rods, were not associated with any of the preoperative variables or indications. In high-risk patient populations, the presented staged management of infected intramedullary hindfoot nails showed promising outcomes for limb preservation.
逆行髓内钉常用于距跟舟关节融合术，以矫正高危患者人群中严重的后足畸形。本研究的目的是报告接受逆行髓内钉固定距跟舟关节融合术后感染分期治疗的患者的结果，并回顾治疗这种危及肢体并发症的手术方法。作者回顾了 2006 年 1 月至 2016 年 12 月期间因感染行后足髓内钉翻修的患者。19 例患者采用抗生素钉分期方案治疗深部感染。平均随访 115.87±92.80（范围 2.29～341.86）周。12 例患者患有糖尿病，10 例患者患有夏科氏神经关节病，7 例患者因足内翻畸形行融合术。16 例患者有周围神经病变，13 例患者有手术肢体溃疡史。19 例患者中有 14 例（73.68%）采用该方案保肢成功。5 例（26.32%）患者行近端截肢，随访期间 3 例（15.79%）死亡。非吸烟者（p=0.01）和胰岛素依赖者（优势比=22，p=0.02）发生截肢的可能性更大，而死亡仅与较高的体重指数相关（p=0.03）。术后使用外部支具的患者，翻修时间也更长（p=0.004）。包括手术总次数和保留的抗生素棒在内的结果与任何术前变量或适应证均无关联。在高危患者人群中，感染的逆行髓内后足钉的分期治疗方案显示出保留肢体的良好结果。
