Levine Joshua, Mavrommatis Sophia, Vang Sandy, Anderson Sarah
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Department of Orthopaedic Surgery, Regions Hospital, St Paul, MN, USA.
Foot Ankle Orthop. 2023 Jan 13;8(1):24730114221148165. doi: 10.1177/24730114221148165. eCollection 2023 Jan.
Patients with neuromuscular diseases such as cerebral palsy (CP) are living longer because of advances in medicine, yielding a larger number of adult patients that could benefit from corrective surgery. However, some surgeons are hesitant to offer surgery to these patients because of concern for postoperative complications. A paucity of literature exists that describes complications in patients undergoing foot and ankle surgery for neuromuscular diseases. The primary study outcome was to identify the postoperative complication rates associated with foot and ankle surgery in adult patients with neuromuscular disease.
The charts of patients with neuromuscular diseases who had foot and ankle surgery by the senior author at a single institution from March 2010 to March 2020 were reviewed. Patient charts were reviewed for demographic data, medical history and diagnoses, and surgical treatment information. Only patients' index procedures with the senior author were evaluated for surgical data. Patient charts were assessed to determine the presence or absence of a postoperative complication following an index procedure.
In a cohort of 42 patients, females comprised 60% of the patient cohort. The average age was 35 (range, 20-69) years old. CP was the most common neuromuscular diagnosis at 52% (22 of 42) patients. Eighteen percent (11 of 60) of the index surgeries had 1 or more complication with a total of 13 complications. The overall wound complication rate was 10% (6 of 60), infection rate was 8% (5 of 60), and the nonunion rate following arthrodesis was 10% (2 of 21).
We conclude that foot and ankle surgery in this complex population can be done safely, with postoperative complication rates similar to the average population. Although these patients may present with unique challenges, surgeons should not forgo surgery out of concern for postoperative complications.
Level IV, retrospective cohort study at a single institution.
由于医学进步，患有脑瘫（CP）等神经肌肉疾病的患者寿命延长，成年患者数量增多，他们可能从矫正手术中获益。然而，一些外科医生因担心术后并发症而不愿为这些患者提供手术。目前关于神经肌肉疾病患者足踝手术并发症的文献较少。主要研究结果是确定成年神经肌肉疾病患者足踝手术后的并发症发生率。
回顾了2010年3月至2020年3月在单一机构由资深作者进行足踝手术的神经肌肉疾病患者的病历。查阅患者病历以获取人口统计学数据、病史和诊断以及手术治疗信息。仅对资深作者进行的首次手术患者的手术数据进行评估。评估患者病历以确定首次手术后是否存在术后并发症。
在42例患者队列中，女性占患者队列的60%。平均年龄为35岁（范围20 - 69岁）。CP是最常见的神经肌肉诊断，占52%（42例中的22例）患者。18%（60例中的11例）的首次手术有1种或更多并发症，共13例并发症。总体伤口并发症发生率为10%（60例中的6例），感染率为8%（60例中的5例），关节融合术后不愈合率为10%（21例中的2例）。
我们得出结论，在这一复杂人群中进行足踝手术可以安全进行，术后并发症发生率与普通人群相似。尽管这些患者可能面临独特挑战，但外科医生不应因担心术后并发症而放弃手术。
IV级，单一机构的回顾性队列研究。
