유관 나사 및 Hybrid형 외고정술을 이용한 당뇨병성 샤르코 족관절 신경관절병증의 관절 유합술
Ankle Arthrodesis using Cannulated Screws & Hybrid Type Rigid External Fixation in Diabetic Charcot Neuroarthropathy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: The diabetic charcot neuroarthropathy of ankle is an infrequent site (around 5%), but is definitely the location that, because of the instability and progressive deformity it involves, cause ulceration in a high percentage of patients, and this can then become a reason for amputation. However, the treatment of this disastrous disease is still challenging. We analyzed the clinical and radiological results of ankle arthrodesis by our fixation method in Charcot neuroarthropathy. Materials and Methods: Seven cases that were diagnosed as charcot neuroarthropathy of ankle arthrodesis were followed for more than 16 months postoperatively. Mean age was 57 years, and the mean follow-up period was 27 months. Anterior approach was used in arthrodesis, and internal fixation by 3 or more cannulated screws and hybrid type external fixation were used. Auto iliac bone for grafting was combined in all cases. External fixator was kept for 3 months without weight-bearing. Then, boots brace was applied for more 3 months allowing partial weight-bearing. Four cases had minor complications such as pin site infection. Preoperative and postoperative AOFAS score, time to fusion and postoperative complications were checked. Results: Postoperative fusion was completed in all cases, and the mean time to fusion was 3.4 months. No postoperative complication was checked. At the last follow-up, the mean AOFAS score had increased from 54 points to 72 points. Patient’s satisfaction was over 80%. Conclusion: Satisfactory results were obtained after ankle arthrodesis using internal and hybrid type external fixation combined with auto iliac bone graft in charcot neuroarthropathy with minor complications.
Abstract
Purpose: The diabetic charcot neuroarthropathy of ankle is an infrequent site (around 5%), but is definitely the location that, because of the instability and progressive deformity it involves, cause ulceration in a high percentage of patients, and this can then become a reason for amputation. However, the treatment of this disastrous disease is still challenging. We analyzed the clinical and radiological results of ankle arthrodesis by our fixation method in Charcot neuroarthropathy. Materials and Methods: Seven cases that were diagnosed as charcot neuroarthropathy of ankle arthrodesis were followed for more than 16 months postoperatively. Mean age was 57 years, and the mean follow-up period was 27 months. Anterior approach was used in arthrodesis, and internal fixation by 3 or more cannulated screws and hybrid type external fixation were used. Auto iliac bone for grafting was combined in all cases. External fixator was kept for 3 months without weight-bearing. Then, boots brace was applied for more 3 months allowing partial weight-bearing. Four cases had minor complications such as pin site infection. Preoperative and postoperative AOFAS score, time to fusion and postoperative complications were checked. Results: Postoperative fusion was completed in all cases, and the mean time to fusion was 3.4 months. No postoperative complication was checked. At the last follow-up, the mean AOFAS score had increased from 54 points to 72 points. Patient’s satisfaction was over 80%. Conclusion: Satisfactory results were obtained after ankle arthrodesis using internal and hybrid type external fixation combined with auto iliac bone graft in charcot neuroarthropathy with minor complications.
참고문헌 (13)
- Pinzur M, "Current concept review: Charcot arthropathy of the foot and ankle", Foot Ankle Int, 28, pp.952~959 (2007)
- Dalla PL, "Use of retrograde nail for ankle arthrodesis in charcot neuroarthropathy: a limb salvage procedure", Foot Ankle Int, 28, pp.967~970 (2007)
- Monroe MT, "Clinical outcome of arthrodesis of the ankle using rigid internal fixation with cancellous screws", Foot Ankle Int, 20, pp.227~231 (1999)
- Pelton K, "Tibiotalocalcaneal arthrodesis using a dynamically locked retrograde intramedullary nail", Foot Ankle Int, 27, pp.759~763 (2006)
- Eylon S, "Outcome of Ilizarov ankle arthrodesis", Foot Ankle Int, 28, pp.873~879 (2007)
- Mueckley TM, "Biomechanical evaluation of primary stiffness of tibiotalar arthrodesis with an intramedullary compression nail and four other fixation devices", Foot Ankle Int, 27, pp.814~820 (2006)
- Hanson TW, "The use of a 95° blade plate and a posterior approach to achieve tibiotalocalcaneal arthrodesis", Foot Ankle Int, 23, pp.704~710 (2002)
- Schon LC, "Charcot neuroarthropathy of the foot and ankle", Clin Orthop Relat Res, 349, pp.116~131 (1998)
- Raikin SM, "Arthrodesis of the ankle: arthroscopic, mini-open, and open techniques", Foot Ankle Clin N Am, 8, pp.347~359 (2003)
- Hockenbury RT, "Use of implantable bone growth stimulation in charcot ankle arthrodesis", Foot Ankle Int, 28, pp.971~976 (2007)
- Coughlin MJ, "The evaluation of the healing rate of subtalar arthrodeses, part 2: the effect of low-intensity ultrasound stimulation", Foot Ankle Int, 29, pp.970~977 (2008)
- Dhawan SK, "The effect of pulsed electromagnetic fields on hindfoot arthrodesis: a prospective study", J Foot Ankle Surg, 43, pp.93~96 (2004)
- Grant WP, "The Utilization of autologous growth factors for the facilitation of fusion in complex neuropathic fractures in the diabetic population", Clin Podiatr Med Surg, 22, pp.561~584 (2005)