Dos Santos-Vaquinhas A, Parra G, Martínez P, Sobrón B, Cuervas-Mons M
Department of Orthopaedics and Trauma Surgery, 'Gregorio Marañón' University Hospital, Madrid, Spain.
Department of Orthopaedics and Trauma Surgery, 'Gregorio Marañón' University Hospital, Madrid, Spain.
Foot (Edinb). 2021 Jun;47:101814. doi: 10.1016/j.foot.2021.101814. Epub 2021 Apr 18.
Charcot neuropathic arthropathy is a progressive degeneration of the weightbearing joints of the foot induced by denervation and disturbance of sensorial perception. This entity clinically behaves as a destructive fast-progressive arthropathy, resulting in loss of independent walking and often requiring amputation of the leg. This study analyzes our experience with midfoot realignment arthrodesis and stabilization by intramedullary beaming in patients with Charcot diabetic foot as a limb-sparing procedure.
Patients with Charcot foot treated in our Foot and Ankle unit between January 2018 and December 2019 were analyzed. In all of the patients beaming technique was performed: open reduction and stabilization by a midfoot medial fusion beam and a lateral fusion bolt. Demographical, clinical and radiological pre and post-surgery data were assessed. The primary outcome measure was defined as an autonomous ambulation through an ulcer-free plantigrade foot. A minimum follow-up of 12 months was performed.
A total of 5 patients were treated. Median age 64 years, mean follow-up 25 months (12-31). An ulcer-free plantigrade foot was obtained in 80% of the patients. Complications were observed in 80% of patients: 1 deep infection, 2 hardware failure, 3 Charcot foot progression. Rate of reoperation 40%, including 1 amputation. Significant improvement in all radiographic angles was observed.
Beaming the medial and lateral columns of the foot in patients with Charcot foot enabled the restoration of a functional plantigrade foot and an ulcer-free autonomous ambulation, despite a relatively high complication rate.
IV, prospective case series.
夏科氏神经性关节病是一种由去神经支配和感觉障碍引起的足部负重关节进行性退变。该疾病在临床上表现为破坏性快速进展性关节病，导致患者无法独立行走，常需截肢。本研究分析了我们对夏科氏糖尿病足患者采用中足复位关节融合术及髓内穿针固定术进行保肢治疗的经验。
分析2018年1月至2019年12月在我们足踝科接受治疗的夏科氏足患者。所有患者均采用穿针技术：通过中足内侧融合棒和外侧融合螺栓进行切开复位和固定。评估手术前后的人口统计学、临床和影像学数据。主要结局指标定义为通过无溃疡的足底着地足实现自主行走。进行了至少12个月的随访。
共治疗5例患者。中位年龄64岁，平均随访25个月（12 - 31个月）。80%的患者获得了无溃疡的足底着地足。80%的患者出现并发症：1例深部感染，2例内固定失败，3例夏科氏足进展。再次手术率为40%，包括1例截肢。所有影像学角度均有显著改善。
对夏科氏足患者的足部内外侧柱进行穿针固定，尽管并发症发生率相对较高，但仍能恢复功能性足底着地足并实现无溃疡的自主行走。
IV级，前瞻性病例系列。
