International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; Division of Podiatry, Northwest Hospital, Randallstown, MD.
J Foot Ankle Surg. 2023 Nov-Dec;62(6):986-990. doi: 10.1053/j.jfas.2023.08.001. Epub 2023 Aug 8.
Charcot neuroarthropathy (CNA) is a progressive disease affecting the bones and joints of the foot that can lead to instability, breakdown, and collapse. Minimally invasive surgery (MIS) techniques are becoming a popular option within musculoskeletal surgery of the foot and ankle and may be an alternative to aggressive dissection seen during corrective surgery. An MIS approach minimizes vascular disruption, provides structural stability at an osteotomy or arthrodesis site, and encourages early mobilization if indicated. This retrospective study compares 17 patients who underwent an open approach for midfoot CNA reconstruction with 17 patients who underwent an MIS approach for midfoot CNA reconstruction. Preoperative and postoperative radiographic parameters were measured: lateral talus-first metatarsal, anteroposterior (AP) talus-first metatarsal, calcaneal pitch, and cuboid height. Difficulties that occurred during treatment were gathered and sorted into postoperative problems (stage I), obstacles (stage II), and complications (stage III). Changes from preoperative to postoperative radiographic lateral talus-first metatarsal and AP talus-first metatarsal angles were statistically significant (p < .001) for both the MIS and open approach. No true postoperative complications (stage III) were observed at last follow-up. The most common difficulty encountered was pin-site infection (stage I; in 23.5% of patients) in the MIS group. In the open group, the most common complications were wound development (stage I; 23.5%) and nonunions (stage II; 23.5%). Our findings suggest that midfoot CNA reconstruction with MIS methods offers similar outcomes to the open approach.
夏科氏关节病（CNA）是一种影响足部骨骼和关节的进行性疾病，可导致不稳定、破裂和塌陷。微创外科（MIS）技术在足踝部运动医学中越来越受欢迎，可能是矫形手术中广泛解剖的替代方法。MIS 方法最大限度地减少血管破坏，在截骨术或关节融合部位提供结构稳定性，并在需要时鼓励早期活动。本回顾性研究比较了 17 例接受开放式中足 CNA 重建的患者和 17 例接受 MIS 方法治疗的患者。测量术前和术后的影像学参数：外侧距骨-第一跖骨、前后（AP）距骨-第一跖骨、跟骨倾斜角和骰骨高度。收集并分类治疗过程中出现的困难，分为术后问题（I 期）、障碍（II 期）和并发症（III 期）。MIS 和开放式方法的术后影像学外侧距骨-第一跖骨和 AP 距骨-第一跖骨角度的变化均具有统计学意义（p<0.001）。末次随访时，未观察到真正的术后并发症（III 期）。MIS 组最常见的困难是针道感染（I 期；在 23.5%的患者中）。在开放式组中，最常见的并发症是伤口愈合不良（I 期；23.5%）和骨不连（II 期；23.5%）。我们的研究结果表明，MIS 方法治疗中足 CNA 重建可获得与开放式方法相似的结果。
