应用踝关节融合术治疗糖尿病患者踝关节骨折后Charcot神经性关节病的疗效观察  

Application of ankle arthrodesis in treatment of diabetic patients with Charcot neuroarthropathy after diabetic ankle fractures

作　　者：龚晓峰[1] 武勇[1] 王岩[1] 李莹[1] 孙宁[1] 赖良鹏[1] 杨磊[1] 邢添威 Gong Xiaofeng;Wu Yong;Wang Yan;Li Ying;Sun Ning;Lai Liangpeng;Yang Lei;Xing Tianwei(Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院足踝外科,北京100035

出　　处：《骨科临床与研究杂志》2018年第6期339-344,352,共7页Journal Of Clinical Orthopedics And Research

摘　　要：目的观察应用踝关节融合术治疗糖尿病患者踝关节骨折后的Charcot神经性关节病(CN)的疗效。方法选取2016年6月至2017年6月北京积水潭医院行踝关节融合术的糖尿病踝关节骨折后的CN患者3例。其中男2例,女1例,平均年龄57岁(55～59岁)。损伤部位:右侧1例,左侧2例。Eichenholtz分期均为Ⅱ期。Sanders和Frykberg解剖部位分型均为4型。3例患者均采用踝关节融合术治疗。观察术后3例患者的切口愈合时间、骨愈合时间及术后并发症,采用美国足踝外科医师协会(AOFAS)踝-后足功能评分标准和疼痛视觉模拟评分(VAS)评估患者的预后。结果 3例均获得随访,平均随访时间19个月(15～25个月)。平均术后切口愈合时间4. 3周(2～9周),平均骨愈合时间15. 7周(10～25周)。末次随访时,3例患者均可脱离支具,穿普通鞋负重行走。1例患者切口不愈合,再次手术后愈合。随访期间未出现内固定断裂、深部感染及截肢等并发症。结论应用踝关节融合术治疗EichenholtzⅡ期糖尿病患者踝关节骨折后CN在术后早期可获得融合端愈合和矫正畸形的目的,能够达到恢复跖行足的效果。Objective To observe the effect of ankle arthrodesis in diabetic patients Charcot neuroarthropathy（CN） after ankle fractures. Methods From June 2016 to June 2017, 3 diabetic patients with CN after ankle fractures were treated with ankle arthrodesis. There were 2 males and one female with an average of 57 years（55-59 years）. There were one case on the right side and 2 cases on the left. Eichenholtz stage were all Phase 1I. Sanders and Frykberg classification were classified as type 4. All defomlities were treated with ankle arthrodesis. The healing time of the soft tissue and bone, postoperative complications were observed, and the prognosis of the 3 patients was evaluated by American Orthopaedic Foot and Ankle Society-（AOFAS） and visual analogue scale score（VAS）. Results Three cases were followed up with an average time of 19 months （15-25 months）. The average wound healing time were 4.3 weeks （2-9 weeks） and average fracture healing time were 15.7 weeks（10-25 weeks）. At the last follow-up, 3 patients were able to walk without any support. One case of the wound complication was healed after debridement and vacuum sealing drainage treatment. No serious complication such as internal fixation breakage, deep infection or amputation occurred. Conclusion Application of ankle arthrodesis in diabetic Eichenoltz Ⅱ CN patients can get good results in healing fusion and correcting the defomfity in the early postoperative period, and restoring the plantigrade foot.

关 键 词：踝关节 关节病 神经原性 关节融合术 糖尿病 

分 类 号：R687.3[医药卫生—骨科学] R587.1[医药卫生—外科学]