Wukich Dane K, Liu George T, Johnson Matthew J, Van Pelt Michael D, Raspovic Katherine M, Lalli Trapper, Nakonezny Paul
Professor and Chair, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
J Foot Ankle Surg. 2022 Nov-Dec;61(6):1334-1340. doi: 10.1053/j.jfas.2022.04.009. Epub 2022 Apr 28.
Charcot neuroarthropathy can cause severe deformity of the midfoot, and intramedullary use of beams and bolts has been utilized as a method of definitive stabilization. This systematic review evaluated the outcomes of intramedullary beaming in patients with Charcot neuroarthropathy and determined the methodological quality of the studies. Four online databases were searched: PubMed, MEDLINE (Clarivate Analytics), CINAHL (Cumulative Index to Nursing and Allied Health) and Web of Science (Clarivate Analytics). To assess the methodological quality of the studies, the Coleman Methodology Score was used. The data was pooled into 2 outcomes groups for comparison: (1) Studies that reported on the outcomes of Charcot specific implants (study group). (2) Studies that reported on the outcomes using non-Charcot specific implants (control group). After screening, 16 studies were included. Compared to our control group, our study group had significantly higher rates of overall hardware complications, hardware migration, surgical site infection, reoperation, and nonunion. The study group had significantly lower rates of limb salvage compared to the control group. Our study and control groups did not differ in the rates of hardware breakage, wound healing complications, or mortality. The limb salvage rate was 92% and 97% of patients were still alive at a mean follow-up of 25 months. The mean Coleman Methodology Score indicated the quality of the studies was poor and consistent with methodologic limitations. The quality of published studies on intramedullary implants for Charcot reconstruction is low. Complications when utilizing intramedullary fixation for Charcot reconstruction are high, whether or not Charcot specific implants are used.
夏科氏神经关节病可导致中足严重畸形，髓内使用横梁和螺栓已被用作一种确定性稳定的方法。本系统评价评估了夏科氏神经关节病患者髓内横梁固定的疗效，并确定了研究的方法学质量。检索了四个在线数据库：PubMed、MEDLINE（科睿唯安）、CINAHL（护理及相关健康累积索引）和Web of Science（科睿唯安）。为评估研究的方法学质量，使用了科尔曼方法学评分。数据被汇总到两个结果组进行比较：（1）报告夏科氏病特定植入物结果的研究（研究组）。（2）报告使用非夏科氏病特定植入物结果的研究（对照组）。筛选后，纳入了16项研究。与我们的对照组相比，我们的研究组在总体硬件并发症、硬件移位、手术部位感染、再次手术和骨不连的发生率上显著更高。与对照组相比，研究组的肢体挽救率显著更低。我们的研究组和对照组在硬件断裂、伤口愈合并发症或死亡率方面没有差异。在平均25个月的随访中，肢体挽救率为92%，97%的患者仍存活。平均科尔曼方法学评分表明研究质量较差，且与方法学局限性一致。关于用于夏科氏病重建的髓内植入物的已发表研究质量较低。无论是否使用夏科氏病特定植入物，在使用髓内固定进行夏科氏病重建时并发症发生率都很高。
