Rana Balvinder, Patel Sandeep
Max Super Specialty Hospital, Press Enclave Marg, Saket, New Delhi and Max Hospital, B Block, Sushant Lok, Gurgaon, Haryana, 122001, India.
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh, 160012, India.
J Clin Orthop Trauma. 2021 Oct 16;23:101637. doi: 10.1016/j.jcot.2021.101637. eCollection 2021 Dec.
The role of arthrodesis as a salvage procedure in Diabetic Charcot Neuroarthropathic deformities of the Foot and Ankle is controversial due to relatively high complication rates reported in literature. We intend to present our experience with a retrospective analysis of Ankle and Hindfoot arthrodesis in deformities due to Diabetic Charcot Neuroarthropathy.
A retrospective observational analysis of selected Diabetic Neuropathic Ankle and Hindfoot cases operated at a single centre.
In a study duration extending 7.5 years, 46 operated sites in 44 patients were included in the study. These patients were treated by one of the following procedures: Tibiotalocalcaneal arthrodesis, Pantalar arthrodesis, Ankle arthrodesis, Triple arthrodesis and isolated subtalar arthrodesis. The results were analysed with regard to wound healing and its complications, clinical and radiological progress of union and non-union rates and deformity correction (i.e. whether a plantigrade foot could be achieved and a standard foot wear could be worn post correction).
There were four superficial and two deep infections (13%). Symptomatic radiological non-union at one or more joints was seen in 12 cases (26%). Thirty cases united primarily (65%) and showed radiological fusion at an average time of 6.8 months post-surgery. Four cases (8.5%) had asymptomatic radiological partial non union at one or more joints but showed clinical union. Five patients (8.3%) had a low energy spiral fracture of the tibia proximal to the locking plate used for TTC fusion. Complete deformity correction with plantigrade foot was achieved in 32 cases (69.5%).
Despite a high complication rate associated with Ankle and Hind foot arthrodesis in Diabetic Charcot Neuroarthropathy, an eventually successful fusion can be achieved in two-third patients.
由于文献报道的并发症发生率相对较高，关节融合术作为足踝部糖尿病夏科氏神经关节病畸形的挽救手术，其作用存在争议。我们打算通过对糖尿病夏科氏神经关节病所致畸形的踝关节和后足关节融合术进行回顾性分析，来介绍我们的经验。
对在单一中心接受手术的选定糖尿病性神经病变踝关节和后足病例进行回顾性观察分析。
在为期7.5年的研究期间，44例患者的46个手术部位纳入研究。这些患者接受了以下手术之一：胫距跟关节融合术、全距关节融合术、踝关节融合术、三关节融合术和单纯距下关节融合术。分析了伤口愈合情况及其并发症、临床和影像学上的愈合及不愈合率以及畸形矫正情况（即矫正后是否能实现足底着地的足型以及能否穿着标准鞋履）。
有4例表浅感染和2例深部感染（13%）。12例（26%）在一个或多个关节出现有症状的影像学不愈合。30例（65%）一期愈合，术后平均6.8个月显示影像学融合。4例（8.5%）在一个或多个关节有无症状的影像学部分不愈合，但临床愈合。5例（8.3%）在用于胫距跟融合的锁定钢板近端发生胫骨低能量螺旋骨折。32例（69.5%）实现了完全畸形矫正且足底着地。
尽管糖尿病夏科氏神经关节病的踝关节和后足关节融合术并发症发生率较高，但三分之二的患者最终可实现成功融合。
