Isfahan university of medical science/orthopedic department, Isfahan, Iran.
J Orthop Surg Res. 2024 Jun 3;19(1):332. doi: 10.1186/s13018-024-04787-9.
Charcot arthropathy is a progressive disorder of the ankle and foot joints that can lead to foot deformity and instability. Surgical intervention is often necessary for deformity and ulcer management during the chronic phase. The device used for arthrodesis remains a challenge.
This clinical trial study included diabetic patients aged 40 years or older with Charcot foot. Lateral approach with lateral malleolar osteotomy was used to access the ankle joints and remove the cartilage. A small incision was made on the plantar aspect of the foot to pass an appropriately sized intramedullary nail. Demographic information, medical history, surgical details and Clinical data were collected at 2-week and 1-year follow-ups using the Ankle-Hindfoot Scale (AOFAS) score and the EuroQol 5-Dimensional 5-Level (EQ-5D-5L) health utility score.
Twenty-six patients with a mean age of 63 ± 0.23 years were included in the study. The findings showed significant improvements in AOFAS questionnaire items related to pain score, length of the walk, walking surfaces, walking disorders, sagittal alignment, back leg alignment, sustainability, alignment and the total score (P value < 0.001). The EQ-5D-5L questionnaire also showed a significant improvement in the total score (P value = 0.002).
This study provides evidence supporting the effectiveness of tibiotalocalcaneal arthrodesis by hindfoot nailing in diabetic patients with Charcot foot joints and demonstrated comparable and superior outcomes in terms of patient satisfaction and complication rate when compared to previous studies.
夏科氏关节病是一种踝关节和足部关节的进行性疾病,可导致足部畸形和不稳定。在慢性期,手术干预通常是必要的,以处理畸形和溃疡。用于关节融合的器械仍然是一个挑战。
本临床试验研究纳入了年龄在 40 岁及以上的糖尿病夏科氏足患者。采用外侧入路外侧踝骨切开术进入踝关节并切除软骨。在足底做一个小切口,穿过一个大小合适的髓内钉。在 2 周和 1 年的随访中,使用踝关节-后足量表(AOFAS)评分和欧洲五维健康量表 5 级(EQ-5D-5L)健康效用评分收集人口统计学信息、病史、手术细节和临床数据。
26 例平均年龄为 63±0.23 岁的患者纳入研究。结果显示,与疼痛评分、步行长度、步行表面、步行障碍、矢状面排列、后腿排列、可持续性、排列和总分相关的 AOFAS 问卷项目均有显著改善(P 值均<0.001)。EQ-5D-5L 问卷总分也有显著改善(P 值=0.002)。
本研究为糖尿病夏科氏足部关节患者通过后足钉钉进行胫距跟关节融合提供了有效性证据,并在患者满意度和并发症发生率方面与以往研究相比表现出相当或更优的结果。