Zhang Hao, Jiang Ning, Zhao Jun-Fei, Zeng Xian-Tie
Foot and Ankle Surgery, Tianjin Hospital, Tianjin, China.
Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
J Orthop Surg Res. 2025 Jul 23;20(1):696. doi: 10.1186/s13018-025-06077-4.
To systematically evaluate the efficacy and safety of intramedullary nails (IMNs) in tibial-talocalcaneal arthrodesis (TTCA) for treating Charcot neuroarthropathy (CN).
A comprehensive search for relevant literature was conducted in the PubMed, Embase, Cochrane Library, Web of Science, Scopus and SinoMed databases, covering studies from 2014 to October 30, 2024. The inclusion criteria were based on the PICOS framework: the study population consisted of CN patients, the intervention was TTCA with IMNs, and the outcomes assessed included bone union rate, complication rate, and limb salvage rate. Statistical analysis was performed using Stata 17.0 software. Literature quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and case series. This systematic review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42025644983).
A total of seven studies involving 147 patients with a mean follow-up of one year were included. The meta-analysis revealed a combined standardized mean difference (SMD) of -4.99 (95% CI: -6.70 to -3.28) for the AOFAS score, with high heterogeneity (I2 = 90.7%). Sensitivity analyses were conducted to assess the stability of the results. The combined estimate for the bone nonunion rate was 3.3% (95% CI: 0.1% to 8.9%), with moderate heterogeneity (I2 = 33.2%). The combined estimate for the infection rate was 12.9% (95% CI: 2.0% to 29.2%). A comparison of preoperative and postoperative scores showed significant improvements in patients' function and quality of life, highlighting the critical role of the TTCA procedure in improving prognosis.
IMNs in TTCA demonstrate high efficacy for CN, with significant functional improvement, low nonunion rates, and favorable limb salvage outcomes. However, infection risks and heterogeneity across studies highlight the need for standardized protocols and larger controlled trials to optimize patient selection and postoperative management.
系统评价髓内钉（IMN）在胫距跟关节融合术（TTCA）治疗夏科氏神经关节病（CN）中的疗效和安全性。
在PubMed、Embase、Cochrane图书馆、Web of Science、Scopus和中国生物医学文献数据库中全面检索相关文献，涵盖2014年至2024年10月30日的研究。纳入标准基于PICOS框架：研究人群为CN患者，干预措施为采用IMN的TTCA，评估的结局包括骨愈合率、并发症发生率和肢体挽救率。使用Stata 17.0软件进行统计分析。采用纽卡斯尔-渥太华量表（NOS）对队列研究和病例系列进行文献质量评估。本系统评价已在国际前瞻性系统评价注册库（PROSPERO；注册号：CRD42025644983）进行前瞻性注册。
共纳入7项研究，涉及147例患者，平均随访1年。荟萃分析显示，美国足踝外科协会（AOFAS）评分的合并标准化均数差（SMD）为-4.99（95%可信区间：-6.70至-3.28），异质性高（I² = 90.7%）。进行敏感性分析以评估结果的稳定性。骨不愈合率的合并估计值为3.3%（95%可信区间：0.1%至8.9%），异质性中等（I² = 33.2%）。感染率的合并估计值为12.9%（95%可信区间：2.0%至29.2%）。术前和术后评分比较显示患者功能和生活质量有显著改善，突出了TTCA手术在改善预后方面的关键作用。
TTCA中的IMN对CN显示出高效性，功能有显著改善，骨不愈合率低，肢体挽救结局良好。然而，感染风险和研究间的异质性凸显了需要标准化方案和更大规模的对照试验，以优化患者选择和术后管理。
