跟腱延长术联合跖骨间截肢术预防前足溃疡。

Concomitant Achilles Tendon Lengthening with Transmetatarsal Amputation for the Prevention of Late Forefoot Ulceration.

机构信息

Department of Podiatric Surgery, College of Medicine, Central Michigan University, Saginaw, Michigan.

Department of Orthopedic Surgery, Covenant Healthcare Foundation, Saginaw, Michigan.

出版信息

J Bone Joint Surg Am. 2022 Oct 5;104(19):1722-1729. doi: 10.2106/JBJS.21.00888. Epub 2022 Aug 18.

DOI:10.2106/JBJS.21.00888

PMID:35984037

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10337308/

Abstract

BACKGROUND

Late development of forefoot ulcers is a common finding after transmetatarsal amputation (TMA). The primary aim of this study was to examine whether concomitant prophylactic Achilles tendon lengthening (ATL) was associated with a reduction in the incidence of forefoot ulcers postoperatively.

METHODS

A retrospective chart review was performed by 2 authors to identify patients who underwent TMA over a period of 5.5 years from January 1, 2015, through July 31, 2020. They identified 110 feet in 107 patients; the 83 patients (85 feet) who had ≥120 days of follow-up were used for the study. Follow-up was performed with telephone calls (80 patients) or during the last office visit (3 patients). Those who were contacted by telephone were asked if they developed an ulcer after healing from the original surgery. Mean follow-up time was 672 ± 258 days for the 30 feet with concomitant Achilles lengthening and 663 ± 434 days for the 55 feet without Achilles lengthening. Demographic data were analyzed for association with late development of forefoot ulceration.

RESULTS

Eighty-five feet were included in the analysis. Late forefoot ulcers developed in 35% of feet that had a TMA alone (n = 55) compared with 3% of feet who received a concomitant ATL (n = 30; p < 0.001); the 2 groups had similar mean follow-up times. Mean time to ulcer development was 587 ± 420 days in the 19 patients without Achilles lengthening. Of the patients who developed late forefoot ulcers, 47% also developed osteomyelitis, and 16% went on to proximal amputation. Patients who developed forefoot ulcers were younger (55 ± 12 versus 63 ± 11 years of age; p = 0.006) than those who did not.

CONCLUSIONS

ATL at the time of TMA is associated with a reduction in the risk of later development of forefoot ulcers, especially in younger patients.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

足前段溃疡是经跖骨截肢（TMA）后常见的晚期并发症。本研究的主要目的是研究预防性跟腱延长术（ATL）是否与术后足前段溃疡的发生率降低有关。

方法

两位作者对 2015 年 1 月 1 日至 2020 年 7 月 31 日期间进行 TMA 的患者进行了回顾性图表审查。他们共确定了 107 名患者的 110 只脚，其中有 83 名患者（85 只脚）随访时间≥120 天，用于本研究。通过电话（80 名患者）或最后一次就诊时（3 名患者）进行随访。通过电话联系的患者被询问他们在最初手术后愈合后是否发生溃疡。接受跟腱延长术的 30 只脚的平均随访时间为 672 ± 258 天，未接受跟腱延长术的 55 只脚的平均随访时间为 663 ± 434 天。对人口统计学数据进行分析，以确定与足前段溃疡晚期发生的相关性。

结果

共纳入 85 只脚进行分析。单独接受 TMA 的 55 只脚中有 35%（n = 55）发生了足前段溃疡，而同时接受 ATL 的 30 只脚中有 3%（n = 30）发生了足前段溃疡（p < 0.001）；两组的平均随访时间相似。在未接受跟腱延长术的 19 名患者中，溃疡发生的平均时间为 587 ± 420 天。在发生足前段溃疡的患者中，47%同时发生骨髓炎，16%进行了近端截肢。发生足前段溃疡的患者比未发生足前段溃疡的患者更年轻（55 ± 12 岁与 63 ± 11 岁；p = 0.006）。