Frøkjær Johnny
University Center for Wound Healing, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark.
J Clin Orthop Trauma. 2021 Feb 11;17:59-64. doi: 10.1016/j.jcot.2021.02.003. eCollection 2021 Jun.
Charcot neuroarthropathy (CN) of the midfoot was traditionally treated non-operatively with off-loading in a total contact cast (TCC). After introduction of the super construct concept, promising results were reported, however there is a need for further studies on this concept. Analysis of non-operative versus operative treatment is presented as well as our results from a consecutive series of 20 patients operated with the superconstruct concept.
Twenty patients were operated from July 2017 until June 2020. Mean age was 58 years (50-80), mean weight was 116 kg (68-156), giving a BMI of 31 (26-45). Preoperative patients off-loaded in a TCC until decreased swelling and skin temperature measurement or ulcer had healed, mean 16 weeks immobilization. Surgery was without tourniquet, using a standard medial and lateral incision. Mean follow up is 24 (5-40) months.
Mean operation time was 227 (150-315) minutes. Medial column fusion was mandatory, in five cases as an isolated procedure, in 12 cases in combination with lateral column fusion and in three cases with a talocalcaneal fusion. Preoperative lateral Meary angle decreased from 23.5 to 9.6°, antero-posterior Meary angle decreased from 16.0 to 4.7°. Eight patients had postoperative incisional wound problems. Four patients had partial implant removal. All healed with a good clinical result. Two patients had an acute Charcot attack in the ankle joint during postoperative mobilization. One had a severe collapse of the talus resulting in a below knee amputation, giving an amputation rate of 5%. Radiographic examination at follow up, showed bone union of all patients. Nineteen patients are ambulated in orthopedic shoes at latest follow up, giving a 95% satisfactory result.
Superconstruct reconstruction of CN midfoot collapse is a safe procedure. There are incisional wound problems, recognition and fast treatment of these complications is important to achieve good results. There is a risk for overloading the ankle, initiating a new acute Charcot attack. Attention must be on this problem. The surgical technique is demanding and should be performed by experienced foot and ankle surgeons in a multidisciplinary team set up.
中足夏科特关节病（CN）传统上采用全接触石膏（TCC）卸载进行非手术治疗。引入超级结构概念后，报告了一些有前景的结果，然而仍需要对该概念进行进一步研究。本文介绍了非手术治疗与手术治疗的分析，以及我们采用超级结构概念对连续20例患者进行手术的结果。
2017年7月至2020年6月对20例患者进行了手术。平均年龄58岁（50 - 80岁），平均体重116千克（68 - 156千克），体重指数为31（26 - 45）。术前患者使用TCC卸载，直至肿胀减轻、皮肤温度测量正常或溃疡愈合，平均固定16周。手术不使用止血带，采用标准的内侧和外侧切口。平均随访时间为24（5 - 40）个月。
平均手术时间为227（150 - 315）分钟。内侧柱融合是必需的，5例为单独手术，12例与外侧柱融合联合进行，3例与距下关节融合联合进行。术前外侧Meary角从23.5°降至9.6°，前后Meary角从16.0°降至4.7°。8例患者术后出现切口伤口问题。4例患者进行了部分植入物取出。所有患者均愈合，临床效果良好。2例患者在术后活动期间踝关节发生急性夏科特发作。1例距骨严重塌陷，导致膝下截肢，截肢率为5%。随访时的影像学检查显示所有患者均骨愈合。在最近一次随访时，19例患者穿着矫形鞋行走，满意度为95%。
CN中足塌陷的超级结构重建是一种安全的手术方法。存在切口伤口问题，识别并快速处理这些并发症对于取得良好结果很重要。存在踝关节过载引发新的急性夏科特发作的风险。必须关注这个问题。手术技术要求较高，应由经验丰富的足踝外科医生在多学科团队环境中进行。
