埋头加压空心钉应用于Charcot关节病中足关节融合的早期疗效

EEaarrllyy results of using headless compression screws in Charcot arthropathy

背景:Charcot关节病累及中足时,因不稳定畸形、复发性溃疡,保守治疗失败率较高。近期几项应用髓内钉固定Charcot关节病中足关节的研究未能得出一致结论。目的:应用埋头加压空心钉融合Charcot关节病不稳定的中足关节,矫正畸形并重建足弓,通过术后随访评价其早期疗效。方法:2016年1月至2016年6月行埋头加压空心钉轴向融合Charcot关节病中足关节5例,年龄52~66岁,平均年龄56.6岁。观察5例患者的术后切口愈合、骨愈合时间,距骨第1跖骨角、Meary角、Pitch角及中足背侧移位,术后并发症以及患者术前与术后的中足AOFAS评分并进行分析。结结果果:5例全部获得随访,随访时间6~12个月,平均9.6个月。患者术后切口愈合时间3~6周,平均3.8周;骨愈合时间12~17周,平均14.8周。距骨第1跖骨角、Meary角、Pitch角、中足背侧移位等影像学评价指标均有明显改善。至末次随访时,患者均可脱离支具穿特制鞋及鞋垫负重行走。1例出现切口浅表感染,经抗生素治疗后痊愈,该患者骨愈合后因螺钉松动行内固定取出。5例患者中不存在内固定断裂、深部感染、甚至截肢等严重并发症。结论:应用埋头加压空心钉进行Charcot关节病的中足关节融合可有效支撑中足内、外侧序列,矫正中足畸形,达到恢复跖行足、预防溃疡的目的,并具有较低的不愈合率。

Background： When the midfoot suffers from Charcot arthropathy, midtarsal joints will become very unstable and ulcers of the plantar sides always are recurrent. Therefore, conservative treatment may have a high failure rate. Recently,several investigators have reported restoring the alignment of the medial column by intramedullary placement of screws, but failed to reach a unanimous conclusion. Objective： To evaluate the short-term efficacy of headless screws in Charcot arthropathy of midfoot. Methods： Five patients with Charcot joint disease who received arthrodesis of midtarsal joints with headless screws in our hospital from January 2016 to June 2016 were enrolled in this study. The average age of them was 56.6years old（range 52-66 years）. The overall functional evaluation included wound healing time, bone union time, talar-first metatarsal angle in AP view, Meary angle, Pitch angle, the dorsal displacement at the apex of the deformity, complications,and American Orthopaedic Foot and Ankle Society（AOFAS） midfoot score. Results： The mean follow-up period was 9.6months（range 6-12 months） in all the patients. The average wound healing time was 3.8 weeks（range 3-6 weeks）. The average bone union time was 14.8 weeks（range 12-17 weeks）. All the radiographic parameters were improved. At the latest medical consultation, all 5 patients can walk weight-bearing without brace or cast, but with costumed shoes or insoles. Superficial infection occurred in one patient and was healed by antibiotics treatment. In this patient, internal fixations were removed 7 months after operation because of screw loosening. No screw breakage, deep infection or amputation occurred.Conclusions： The headless compression screw is very effective in surgical arthrodesis treatment of midfoot Charcot joint disease. It can reconstruct the beam structure of midfoot, correct the deformity, have sufficient strength to maintain the plantigrade foot, and decrease the risks of ulcers, nonunion and deep infection.