University of Texas Southwestern Medical School, Dallas, TX, USA.
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Division of Orthopaedic Surgery, Veterans Affairs North Texas Health Care System, Dallas, TX, USA.
J Diabetes Complications. 2021 Dec;35(12):108071. doi: 10.1016/j.jdiacomp.2021.108071. Epub 2021 Oct 6.
Charcot neuroarthropathy (CN) is an inflammatory arthropathy associated with bony destruction, dislocation, and deformity in patients with neuropathy. Surgical procedures involving foot and ankle in CN for deformity correction have been shown to result in high rate of complications. The purpose of this study was to compare post-operative outcomes and assess odds of complication after ankle arthrodesis among patients with diabetes-related Charcot neuroarthropathy, non-Charcot patients with diabetes, and non-Charcot patients without diabetes.
The PearlDiver Patient Records Database was queried for patients who underwent ankle fusion and maintained at least one year of post-operative follow-up. The following post-operative complications were assessed among groups: overall nonunion and amputation, one-year nonunion, amputation, and hardware removal, 90-day and 30-day surgical site infection, dehiscence, acute kidney injury, and pneumonia, and 90-day myocardial infarction and deep vein thrombosis. The odds and prevalence of each complication for each group were assessed and compared.
Higher rates of amputation (OR 3.43, CI 2.89-4.06), hardware removal (OR 1.63, CI 1.45-1.83), wound dehiscence (OR 1.75, CI 1.44-2.13), acute kidney injury (OR 2.87, CI 2.32-3.54), pneumonia (OR 1.53, CI 1.13-2.07), and surgical site infection (OR 2.46, CI 2.12-2.85), were observed in patients with diabetes-related CN compared to non-Charcot patients with diabetes. In patients without CN, higher rates of nonunion (OR 1.38, CI 1.19-1.61), amputation (OR 2.26, CI 1.74-2.93), surgical site infection (OR 1.57, CI 1.30-1.90), and acute kidney injury (OR 1.57, CI 1.18-2.09) were observed in patients with diabetes compared to patients without diabetes. Time to hardware removal was significantly shorter in diabetes-related Charcot patients compared to non-Charcot patients without diabetes (368.0 ± 446.7 vs 438.5 ± 487.5 days, P < 0.001).
Patients with diabetes demonstrated increased odds of nonunion, amputation, surgical site infection, and acute kidney injury compared to patients without diabetes. In the population of patients with diabetes, odds of most of these complications were further increased with the addition of Charcot diagnosis compared to patients without diabetes. Other local and multisystemic medical conditions, including pneumonia and wound dehiscence, also demonstrated increased odds in patients of CN.
Cohort study; Level of evidence, 3.
夏科氏神经关节病（CN）是一种炎症性关节病，与神经病变患者的骨破坏、脱位和畸形有关。CN 患者足部和踝关节的矫形手术已被证明会导致高并发症发生率。本研究的目的是比较糖尿病相关夏科氏神经关节病患者、糖尿病非夏科氏患者和非糖尿病非夏科氏患者在接受踝关节融合术后的术后结果，并评估并发症的发生几率。
从 PearlDiver 患者记录数据库中查询接受踝关节融合术并至少有一年术后随访的患者。评估各组的以下术后并发症：总体骨不连和截肢、一年骨不连、截肢和内固定取出、90 天和 30 天手术部位感染、切口裂开、急性肾损伤和肺炎，以及 90 天心肌梗死和深静脉血栓形成。评估并比较每组每个并发症的几率和发生率。
与糖尿病非夏科氏患者相比，糖尿病相关 CN 患者的截肢（OR 3.43，95%CI 2.89-4.06）、内固定取出（OR 1.63，95%CI 1.45-1.83）、切口裂开（OR 1.75，95%CI 1.44-2.13）、急性肾损伤（OR 2.87，95%CI 2.32-3.54）、肺炎（OR 1.53，95%CI 1.13-2.07）和手术部位感染（OR 2.46，95%CI 2.12-2.85）的发生率更高。在无 CN 患者中，与无糖尿病患者相比，糖尿病患者的骨不连（OR 1.38，95%CI 1.19-1.61）、截肢（OR 2.26，95%CI 1.74-2.93）、手术部位感染（OR 1.57，95%CI 1.30-1.90）和急性肾损伤（OR 1.57，95%CI 1.18-2.09）的发生率更高。与非糖尿病非夏科氏患者相比，糖尿病相关夏科氏患者的内固定取出时间明显缩短（368.0±446.7 与 438.5±487.5 天，P<0.001）。
与无糖尿病患者相比，糖尿病患者的骨不连、截肢、手术部位感染和急性肾损伤的几率更高。在糖尿病患者中，与无糖尿病患者相比，CN 患者的这些并发症的几率进一步增加，而与非糖尿病患者相比，CN 患者的其他局部和多系统医学并发症，包括肺炎和切口裂开，也增加了几率。
队列研究；证据水平，3 级。
