后足夏科氏重建术后内固定失败和不愈合的预测因素。
Predictors of metalwork failure and nonunion after hindfoot Charcot reconstruction.
机构信息
Department of Trauma and Orthopaedic Surgery, King's College Hospital, London, UK.
出版信息
Bone Joint J. 2022 Jun;104-B(6):703-708. doi: 10.1302/0301-620X.104B6.BJJ-2022-0127.
AIMS
Surgical reconstruction of deformed Charcot feet carries a high risk of nonunion, metalwork failure, and deformity recurrence. The primary aim of this study was to identify the factors contributing to these complications following hindfoot Charcot reconstructions.
METHODS
We retrospectively analyzed patients who underwent hindfoot Charcot reconstruction with an intramedullary nail between January 2007 and December 2019 in our unit. Patient demographic details, comorbidities, weightbearing status, and postoperative complications were noted. Metalwork breakage, nonunion, deformity recurrence, concurrent midfoot reconstruction, and the measurements related to intramedullary nail were also recorded.
RESULTS
There were 70 patients with mean follow-up of 54 months (SD 26). Overall, 51 patients (72%) and 52 patients (74%) were fully weightbearing at one year postoperatively and at final follow-up, respectively. The overall hindfoot union rate was 83% (58/70 patients). Age, BMI, glycated haemoglobin, and prior revascularization did not affect union. The ratio of nail diameter and isthmus was greater in the united compared to the nonunited group (0.90 (SD 0.06) and 0.86 (SD 0.09), respectively; p = 0.034). In those with a supplementary hindfoot compression screw, there was a 95% union rate (19/20 patients), compared to 78% in those without screws (39/50 patients; p = 0.038). All patients with a miss-a-nail hindfoot compression screw went on to union. Hindfoot metalwork failure was seen in 13 patients (19%). An intact medial malleolus was found more frequently in those with intact metalwork ((77% (44/57 patients) vs 54% (7/13 patients); p = 0.022) and in those with union ((76% (44/58 patients) vs 50% (6/12 patients); p = 0.018). Broken metalwork occurred more frequently in patients with nonunions (69% (9/13 patients) vs 9% (5/57 patients); p < 0.001) and midfoot deformity recurrence (69% (9/13 patients) vs 9% (5/57 patients); p < 0.001).
CONCLUSION
Rates of hindfoot union and intact metalwork were noted in over 80% of patients. Union after hindfoot reconstruction occurs more frequently with an isthmic fit of the intramedullary nail and supplementary hindfoot screws. An intact medial malleolus is protective against nonunion and hindfoot metalwork failure. Cite this article: 2022;104-B(6):703-708.
目的
足部夏科氏畸形的手术重建有很高的不愈合、内固定失败和畸形复发风险。本研究的主要目的是确定影响跟骨夏科氏重建后这些并发症的因素。
方法
我们回顾性分析了 2007 年 1 月至 2019 年 12 月期间在我科接受跟骨夏科氏重建的患者。记录患者的人口统计学资料、合并症、负重状态和术后并发症。还记录了内固定物断裂、不愈合、畸形复发、同时行中足重建和与髓内钉相关的测量值。
结果
共有 70 例患者，平均随访 54 个月（标准差 26）。总体而言，51 例（72%）和 52 例（74%）患者在术后 1 年和最终随访时完全负重。总的跟骨愈合率为 83%（70 例患者中的 58 例）。年龄、BMI、糖化血红蛋白和先前的血运重建均不影响愈合。愈合组的钉直径与峡部的比值大于未愈合组（0.90（SD 0.06）和 0.86（SD 0.09），p = 0.034）。在使用补充后足压缩螺钉的患者中，愈合率为 95%（20 例中的 19 例），而未使用螺钉的患者中愈合率为 78%（50 例中的 39 例；p = 0.038）。所有错过跟骨压缩螺钉的患者都愈合了。13 例（19%）患者出现后足金属内固定物失败。金属内固定物完整的患者中，内侧距完整的比例更高（77%（57 例患者中的 44 例）vs. 54%（13 例患者中的 7 例）；p = 0.022）和金属内固定物愈合的比例更高（76%（58 例患者中的 44 例）vs. 50%（12 例患者中的 6 例）；p = 0.018）。金属内固定物断裂更常见于未愈合的患者（69%（13 例患者中的 9 例）vs. 9%（57 例患者中的 5 例）；p < 0.001）和中足畸形复发的患者（69%（13 例患者中的 9 例）vs. 9%（57 例患者中的 5 例）；p < 0.001）。
结论
超过 80%的患者出现了跟骨愈合和完整的金属内固定物。跟骨重建后，峡部合适的髓内钉和补充后足螺钉更有助于愈合。完整的内侧距可预防不愈合和后足金属内固定物失败。
引用：2022;104-B(6):703-708.
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