糖尿病性踝关节骨折的一期关节融合术。
Primary Arthrodesis for Diabetic Ankle Fractures.
作者信息
Grote Caleb W, Tucker William, Stumpff Kelly, Birt Mitchell C, Horton Greg A
机构信息
Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
出版信息
Foot Ankle Orthop. 2020 Mar 24;5(1):2473011420908841. doi: 10.1177/2473011420908841. eCollection 2020 Jan.
BACKGROUND
Treatment of ankle fractures in patients with diabetes is associated with increased complication rates. Ankle arthrodesis is considered a salvage procedure after failed ankle fracture fixation, yet primary ankle arthrodesis has been proposed as a treatment option for patients with significant diabetes-related complications. To date, the characteristics of patients who undergo primary ankle arthrodesis and the associated outcomes have not been described.
METHODS
A retrospective review was performed of 13 patients with diabetes who underwent primary arthrodesis for traumatic ankle fracture. Patient demographics were characterized in addition to their diabetes complications, Adelaide Fracture in the Diabetic Ankle (AFDA) score, and fracture type. Outcomes assessed included reoperation rates, infection rates, wound complications, nonunion/malunion, amputation, and development of Charcot arthropathy postoperatively.
RESULTS
Patients who underwent primary arthrodesis had high rates of diabetes complications, average AFDA scores of 6.4, and high rates of severe injuries, including 38.5% open fractures and 69.2% fracture dislocations. The overall complication rate for primary arthrodesis of ankle fractures in diabetes patients was more than 75% in this cohort. Complications included a 38.5% reoperation rate, 38.5% infection rate, 53.8% wound complication rate, and 23.1% amputation rate. Despite a high nonunion rate at the attempted fusion sites, 89.9% of fractures healed and patients had a stable extremity.
CONCLUSION
This review is the first to characterize the epidemiology and complications of diabetes patients undergoing primary ankle arthrodesis for ankle fractures. In this cohort, patients with multiple diabetic complications and severe injuries underwent primary arthrodesis, which led to an overall high complication rate. Further research is needed to determine the appropriate treatment option for these high-risk patients, and tibiotalocalcaneal stabilization without arthrodesis may be beneficial.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
背景
糖尿病患者踝关节骨折的治疗与并发症发生率增加相关。踝关节融合术被认为是踝关节骨折内固定失败后的挽救性手术，但对于有严重糖尿病相关并发症的患者，一期踝关节融合术已被提议作为一种治疗选择。迄今为止，接受一期踝关节融合术的患者特征及相关结局尚未见描述。
方法
对13例因创伤性踝关节骨折接受一期融合术的糖尿病患者进行回顾性研究。除了糖尿病并发症、阿德莱德糖尿病踝关节骨折（AFDA）评分和骨折类型外，还对患者人口统计学特征进行了描述。评估的结局包括再次手术率、感染率、伤口并发症、骨不连/畸形愈合、截肢以及术后夏科氏关节病的发生情况。
结果
接受一期融合术的患者糖尿病并发症发生率高，AFDA平均评分为6.4，严重损伤发生率高，包括38.5%的开放性骨折和69.2%的骨折脱位。该队列中糖尿病患者踝关节骨折一期融合术的总体并发症发生率超过75%。并发症包括38.5%的再次手术率、38.5%的感染率、53.8%的伤口并发症率和23.1%的截肢率。尽管在尝试融合部位骨不连率较高，但89.9%的骨折愈合，患者肢体稳定。
结论
本综述首次描述了因踝关节骨折接受一期踝关节融合术的糖尿病患者的流行病学特征和并发症。在该队列中，有多种糖尿病并发症和严重损伤的患者接受了一期融合术，导致总体并发症发生率较高。需要进一步研究以确定这些高危患者的合适治疗选择，不进行融合的胫距跟关节稳定术可能有益。
证据级别
IV级，回顾性病例系列。
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