International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
Veterans Affairs Maryland Health Care System, Baltimore, MD.
J Foot Ankle Surg. 2023 Nov-Dec;62(6):977-980. doi: 10.1053/j.jfas.2023.07.007. Epub 2023 Jul 29.
Charcot neuroarthropathy (CNA) is a progressive disease that affects the bones and joints of the foot. To prevent collapse and loss of stability within the pedal architecture, CNA should be diagnosed and managed early. The objective of this retrospective study was to review patients who underwent midfoot CNA reconstructive surgery and evaluate subsequent rates of minor and major amputations. Secondary objectives include identifying patients that underwent midfoot CAN with and without a subtalar joint (STJ) arthrodesis. Out of the 72 patients, 4 (5.6%) underwent minor (digital, ray) amputation, 2 (2.8%) underwent proximal amputations (either below or above the knee), and none underwent midfoot amputation (transmetatarsal, Lisfranc, Chopart). A Fisher's exact test was employed to compare the outcomes of minor and major amputation rates in our CNA cohort with those who underwent midfoot CNA reconstruction with STJ arthrodesis and found no statistical significance (p = .15). Overall, a total progression to amputation was 8.4% following midfoot CNA reconstruction, with 2.8% of patients undergoing major amputation (below knee or above knee). Despite no statistical significance, we recommend surgeons to consider including an STJ arthrodesis in addition to midfoot CNA reconstruction to establish a stable and plantigrade foot.
夏柯氏关节病（CNA）是一种影响足部骨骼和关节的进行性疾病。为了防止足弓结构塌陷和丧失稳定性，应及早诊断和治疗 CNA。本回顾性研究的目的是回顾接受中足 CNA 重建手术的患者，并评估随后发生小截肢和大截肢的比率。次要目标包括确定接受中足 CNA 手术且伴或不伴距下关节（STJ）融合术的患者。在 72 例患者中，有 4 例（5.6%）接受了小截肢（数字、射线），2 例（2.8%）接受了近端截肢（膝下或膝上），无中足截肢（跖骨间、Lisfranc、Chopart）。采用 Fisher 确切概率法比较我们的 CNA 队列中小截肢和大截肢率与接受中足 CNA 重建伴 STJ 融合术患者的结果，无统计学意义（p=0.15）。总体而言，中足 CNA 重建后截肢的总进展率为 8.4%，2.8%的患者行大截肢（膝下或膝上）。尽管无统计学意义，但我们建议外科医生考虑在中足 CNA 重建的基础上增加 STJ 融合术，以建立稳定的足底负重足。
