*Department of Podiatric Surgery, Yale New Haven Hospital, New Haven, CT.
†Department of Surgery, Yale University School of Medicine, New Haven, CT.
J Am Podiatr Med Assoc. 2024 Jul-Aug;114(4). doi: 10.7547/23-092.
Charcot's neuroarthropathy complicated by calcaneal osteomyelitis can be difficult to treat. Various surgical techniques describe how to manage these conditions. Eggshell-type debridement with application of antibiotic-impregnated bone substitute is a viable option that eliminates infected bone and allows staged reconstructive surgery. A 50-year-old woman with right midfoot Charcot's neuroarthropathy presented with osteomyelitis of the cuboid and fourth and fifth metatarsal bases after resection and failed antibiotic therapy. The patient eventually developed adductovarus, septic shock, and hematogenous osteomyelitis of the calcaneus, navicular, and lateral cuneiform. Vacuum-assisted eggshell-type debridement was performed, and the calcaneal defect was filled with antibiotic-impregnated calcium sulfate and calcium phosphate. Eight weeks after the initial surgery, the infection resolved; however, the patient had trouble walking. She underwent staged Charcot's reconstructive surgery with application of a dynamic multiplanar external fixator with gradual deformity and split-thickness skin graft to cover the residual plantar lateral foot wound. The second stage included septic fusion of the midfoot and subtalar joint from the frame. Twelve weeks postoperatively, radiographic union was achieved, the external fixator was removed, and the patient demonstrated a plantigrade foot. She was transitioned to a total-contact cast and allowed to bear weight as tolerated. Eighteen months after the initial procedure, the patient is wound-free and weightbearing in a CROW boot. This innovative eggshell-type debridement technique aspirates osteomyelitic cancellous bone while preserving cortical bone. It can be particularly useful in hematogenous osteomyelitis, where cortical integrity is not breached, or in situations where there is minimal cortical involvement. Specifically preserving the calcaneus, a major weightbearing bone, permits subsequent reconstructive surgical planning. At 18 months, there were no signs of osteomyelitis recurrence.
夏科氏神经关节病并发跟骨骨髓炎的治疗可能较为困难。各种手术技术都描述了如何处理这些情况。蛋壳样清创术联合应用抗生素骨替代物是一种可行的选择，可清除感染的骨骼并允许分期重建手术。一位 50 岁的女性，因右中足夏科氏神经关节病行手术切除后，出现第四和第五跖骨基底的骨髓炎，且抗生素治疗失败。患者最终出现内收内旋畸形、感染性休克和跟骨、舟骨和外侧楔骨的血源性骨髓炎。进行了负压辅助蛋壳样清创术，并用抗生素骨水泥硫酸钙和磷酸钙填充跟骨缺损。初次手术后 8 周，感染得到控制；然而，患者行走困难。她接受了分期夏科氏重建手术，应用动态多平面外固定架逐渐矫正畸形，并用皮片移植覆盖残余的足底外侧足伤口。第二期手术包括从中固定架融合中足和距下关节。术后 12 周，获得影像学愈合，拆除外固定架，患者足部为平足。她过渡到全接触石膏并允许在可耐受的情况下负重。初次手术后 18 个月，患者伤口愈合良好，可负重行走。她使用 CROW 靴。这种创新性的蛋壳样清创技术可抽吸骨髓炎松质骨，同时保留皮质骨。在皮质完整未受侵犯或皮质受累最小的情况下，它特别有用。特别保留主要负重骨骼跟骨，可以为随后的重建手术规划提供便利。在 18 个月时，没有骨髓炎复发的迹象。
