PDF(Sci-hub)
Abstract：
Retrograde intramedullary nails are often used for tibiotalocalcaneal arthrodesis to correct severe hindfoot deformities in high-risk patient populations. The purposes of the current study are to report outcomes of patients undergoing staged management of infection after intramedullary nail fixation for tibiotalocalcaneal arthrodesis and to review the surgical approach to management of this limb-threatening complication. The authors reviewed patients who underwent hindfoot intramedullary nailing with subsequent revision for infection between January 2006 and December 2016. Staged protocol with antibiotic nail for the management of deep infection was used in 19 patients. The mean follow-up was 115.87 ± 92.80 (range 2.29 to 341.86) weeks. Twelve of the patients had diabetes, 10 had Charcot neuroarthropathy, and 7 had arthrodesis for equinovarus deformity. Sixteen had peripheral neuropathy and 13 had history of ulceration on the operated extremity. Limb salvage with the use of this protocol was achieved in 14 (73.68%) of 19 patients. Five (26.32%) patients had proximal amputation with 3 (15.79%) deaths within the follow-up period. Amputation was more likely in the nonsmoking (p = .01) and insulin-dependent (odds ratio = 22, p = .02) patient cohorts, whereas death was associated only with higher body mass index (p = .03). Time to revision was greater in patients with external bracing postoperatively as well (p = .004). Outcomes, including total number of procedures and retained antibiotic rods, were not associated with any of the preoperative variables or indications. In high-risk patient populations, the presented staged management of infected intramedullary hindfoot nails showed promising outcomes for limb preservation.
摘要：
逆行髓内钉通常用于胫骨关节固定术，以纠正高危患者人群中严重的后足畸形。本研究的目的是报告在髓内钉固定治疗胫骨关节固定术后接受分阶段感染的患者的结果，并回顾治疗这种威胁肢体并发症的手术方法。作者回顾了2006年1月至2016年12月期间接受后足髓内钉治疗并随后进行感染翻修的患者。19例患者使用抗生素钉治疗深部感染的分期方案。平均随访时间为115.87±92.80（范围2.29至341.86）周。12名患者患有糖尿病，10人患有Charcot神经关节病，7人因马蹄内翻足畸形进行关节固定术。16例患有周围神经病变，13例有手术肢体溃疡史。19例患者中有14例（73.68％）使用该方案进行了肢体抢救。随访期内有5例（26.32％）患者发生近端截肢，其中3例（15.79％）死亡。在非吸烟（p=0.01）和胰岛素依赖性（比值比=22，p=0.02）患者队列中，截肢的可能性更大，而死亡仅与较高的体重指数相关（p=0.03）。术后使用外部支撑的患者的修正时间也更长（p=.004）。结果，包括手术总数和保留的抗生素棒，与任何术前变量或适应症无关。在高危患者人群中，所提出的感染的髓内后足钉的分阶段管理显示了肢体保存的有希望的结果。
