Kim Sunghoo, Lee Ho-Seong, Choi Youngrak
Department of Orthopedic Surgery, Chungbuk National University Hospital, Cheongju, Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2025 Apr;17(2):331-339. doi: 10.4055/cios24319. Epub 2025 Mar 14.
Patients with severe hindfoot Charcot neuroarthropathy may experience various complications following tibiotalocalcaneal arthrodesis. Therefore, it is crucial to establish appropriate treatment plans to prevent potential complications and predict prognosis before surgery. This study aimed to investigate the impact of the degree of preoperative deformity in hindfoot Charcot neuroarthropathy on the outcomes of tibiotalocalcaneal arthrodesis.
Twenty patients who underwent tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy were grouped by the severity of their deformities into a mild deformity group (tibiotalar angle between 80° and 100° with minimal or no talar osteolysis) and a severe deformity group (tibiotalar angle < 80° or > 100°, or severe talar osteolysis precluding tibiotalocalcaneal arthrodesis and necessitating tibiocalcaneal arthrodesis). Their demographics, comorbidities, and various surgical outcomes were compared between the 2 groups. Additional analyses were conducted to determine the factors associated with poor clinical outcome, defined as the inability to achieve independent ambulation or the need for below-knee amputation.
There were no significant differences in demographics and comorbidities between the 2 groups. Postoperative clinical outcomes, including the rate of postoperative infection and poor clinical outcome (inability to walk independently or having undergone below-knee amputation), showed no significant differences between the 2 groups. In terms of radiological outcomes, the bony union rates were 66.7% in the mild deformity group and 54.5% in the severe deformity group, with no significant difference. Similarly, other radiological outcomes, such as postoperative malalignment and time to union, did not vary significantly between the 2 groups. Factors associated with poor clinical outcome were the presence of preoperative infected wound and postoperative infection.
The severity of preoperative coronal deformity or talar osteolysis was not associated with clinical or radiological outcomes of tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy. However, preoperative infected wound and postoperative infection were associated with poor clinical outcomes. Therefore, instead of early amputation in cases of severe coronal deformity or insufficient talar bone stock, limb salvage with tibiotalocalcaneal arthrodesis may be a viable alternative, with particular attention to patients with preoperative infected wound and postoperative infection.
重度后足夏科特神经关节病患者在胫距跟关节融合术后可能会出现各种并发症。因此，在手术前制定适当的治疗方案以预防潜在并发症并预测预后至关重要。本研究旨在探讨后足夏科特神经关节病术前畸形程度对胫距跟关节融合术疗效的影响。
20例行胫距跟关节融合术治疗后足夏科特神经关节病的患者，根据畸形严重程度分为轻度畸形组（胫距角在80°至100°之间，距骨骨质溶解轻微或无）和重度畸形组（胫距角<80°或>100°，或严重距骨骨质溶解，无法进行胫距跟关节融合术而需行胫跟关节融合术）。比较两组患者的人口统计学资料、合并症及各项手术结局。进行额外分析以确定与临床结局不佳相关的因素，临床结局不佳定义为无法实现独立行走或需要行膝下截肢。
两组患者的人口统计学资料和合并症无显著差异。术后临床结局，包括术后感染率和临床结局不佳（无法独立行走或已行膝下截肢），两组间无显著差异。在影像学结局方面，轻度畸形组的骨愈合率为66.7%，重度畸形组为54.5%，无显著差异。同样，两组间其他影像学结局，如术后畸形和愈合时间，也无显著差异。与临床结局不佳相关的因素是术前存在感染伤口和术后感染。
后足夏科特神经关节病胫距跟关节融合术的术前冠状面畸形严重程度或距骨骨质溶解情况与临床或影像学结局无关。然而，术前感染伤口和术后感染与临床结局不佳相关。因此，对于冠状面畸形严重或距骨骨量不足的病例，可不进行早期截肢，采用胫距跟关节融合术进行保肢可能是一种可行的选择，尤其要关注术前有感染伤口和术后感染的患者。
