Subawa Wayan, Nugraha Hans K, Afandi Richard, Rusdianto Ignatius A
Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Indonesia.
Ann Med Surg (Lond). 2021 Nov 27;73:103078. doi: 10.1016/j.amsu.2021.103078. eCollection 2022 Jan.
Charcot neuroarthropathy (CN) is a degenerative, progressive disease affecting the ankle and foot and it is usually a disabling factor in diabetic patients. Surgical management of CN aims to obtain a painless stable plantigrade foot which can be achieved through fusion. Achieving joint arthrodesis in CN usually carries a high failure rate.
We presented two patients with late-stage CN foot deformity. The first case is a 52-year-old female with CN on her left ankle and presented without any infection or prior correction. The second case reported a 47-year-old man with complaints of deformity on his right ankle, he had undergone surgical treatment with an external fixator before, and now presented with infection in the surgical site.
Ankle arthrodesis has been considered by many as the treatment of choice for severe and late-stage CN foot. This treatment aims to give a rigid enough fixation which will maintain the stability of the ankle joint and prevents further destruction of surrounding tissue. Multiple modalities of treatment are available and must be chosen accordingly to each clinical case. Minimal implants and the use of multiple bone grafts could be considered as a plan of treatment. Both patients have promising and positive results from the two procedures.
Treatment of CN Foot with internal plate fixation combined with fibular strut graft seemed to give promising results, both radiographically and functionally. Furthermore, a slight modification of treatment with a minimal implant or iliac graft may be considered.
夏科氏关节病（CN）是一种影响踝关节和足部的退行性、进行性疾病，通常是糖尿病患者致残的一个因素。CN的手术治疗旨在获得无痛、稳定的足底着地的足部，这可通过融合术来实现。在CN中实现关节融合术通常失败率很高。
我们展示了两名晚期CN足部畸形患者。第一例是一名52岁女性，左脚踝患有CN，就诊时无任何感染或既往矫正史。第二例报告的是一名47岁男性，主诉右脚踝畸形，他之前接受过外固定器手术治疗，现在手术部位出现感染。
许多人认为踝关节融合术是重度和晚期CN足部的首选治疗方法。这种治疗旨在提供足够坚固的固定，以维持踝关节的稳定性并防止周围组织进一步破坏。有多种治疗方式可供选择，必须根据每个临床病例相应地进行选择。可考虑采用最小化植入物和使用多种骨移植作为一种治疗方案。两名患者的这两种手术都取得了有希望的积极结果。
采用内固定钢板联合腓骨支撑植骨治疗CN足部，在影像学和功能方面似乎都取得了有希望的结果。此外，可考虑对治疗方案进行微调，采用最小化植入物或髂骨移植。
