Bajuri Mohd Yazid, Ong Shir Lee, Das Srijit, Mohamed Isa Naina
Department of Orthopaedic and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Department of Human Clinical Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Front Surg. 2022 Mar 8;9:820826. doi: 10.3389/fsurg.2022.820826. eCollection 2022.
Charcot neuroarthropathy of the ankle and the hindfoot is a complex clinical entity with a high risk of amputation. Charcot neuroarthropathy limb reconstruction has been proposed as a limb-salvaging procedure. However, there was a lack of information on the various available reconstruction methods, including the outcomes and complications. The present study aimed to evaluate the current literature and update on the trends regarding the surgical management of Charcot neuroarthropathy of the ankle and the hindfoot.
All data published from January 2010 to January 2020 that investigated the methods of fixation and their respective outcomes for the surgical reconstruction in Charcot neuroarthropathy were analyzed. The union rate, amputation rates, and complications associated with these techniques were taken for statistical analysis.
A total of 16 studies fit the inclusion criteria of this study, with four Level-III studies and 12 Level-IV studies were included. Ten studies utilized internal fixation only; five used a combination of internal fixation and circular external fixator, whereby there are three comparative studies between internal and external fixations, and two studies applied combined technique of internal and external fixations (hybrid fixation). One study describes the usage of circular external fixation only.
The use of retrograde intramedullary nail as a treatment of choice in the reconstruction of Charcot neuroarthropathy ankle is recommended before an ulcer occurrence. Hydroxyapatite (HA)- coated screws are recommended for the locking mechanism to prevent migration in Charcot neuroarthropathy due to poor bony quality. Hybrid fixation is recommended for reconstruction in a condition of ulceration and more complex deformity as it provides a higher rate of limb salvage with less soft tissue irritation.
踝关节和后足的夏科氏神经关节病是一种截肢风险很高的复杂临床病症。夏科氏神经关节病肢体重建已被提议作为一种保肢手术。然而，关于各种可用的重建方法，包括其结果和并发症，缺乏相关信息。本研究旨在评估当前文献，并更新踝关节和后足夏科氏神经关节病手术治疗的趋势。
分析2010年1月至2020年1月发表的所有研究夏科氏神经关节病手术重建固定方法及其各自结果的数据。对这些技术的愈合率、截肢率和并发症进行统计分析。
共有16项研究符合本研究的纳入标准，其中包括4项III级研究和12项IV级研究。10项研究仅采用内固定；5项采用内固定和环形外固定器相结合的方法，其中有3项内固定与外固定的比较研究，2项研究应用了内固定和外固定相结合的技术（混合固定）。1项研究仅描述了环形外固定的使用情况。
建议在溃疡发生前，使用逆行髓内钉作为夏科氏神经关节病踝关节重建的首选治疗方法。对于因骨质质量差导致夏科氏神经关节病的锁定机制，建议使用羟基磷灰石（HA）涂层螺钉以防止移位。对于溃疡和更复杂畸形情况的重建，建议采用混合固定，因为它能提供更高的保肢率且软组织刺激较小。
