Abstract：
BACKGROUND: Given the paucity of literature on the management of infected metalwork and nonunion in neuropathic diabetic patients, a meta-analysis was designed to investigate the two major complications following Charcot reconstruction performed by means of internal fixation methods.
METHODS: We searched PubMed, Scopus and CENTRAL until the 17th of May 2022 for completed studies investigating outcomes following midfoot and/or hindfoot and/or ankle diabetic Charcot reconstruction. For a paper to qualify for inclusion, an internal fixation element should have been considered. Random effects meta-analysis of proportion was performed to calculate the rate of post-operative deep-seated infections with the associated amputation rate and nonunions by using Open Meta-analyst software. Sub-analysis linked to anatomical location of reconstruction was performed and the quality of the included studies was appraised using the Moga tool.
RESULTS: Thirty studies with 492 eligible reconstructions were considered. Of those, deep-seated infections were diagnosed in 46 cases (Estimated proportion was 6.7%, 95% CI [4.2%-9.2%]). Debridement and antibiotic administration with or without metalwork removal were considered in the majority of the participants with successful clinical outcomes. Amputation was performed in 15 patients due to unmanageable post-operative infection and nonunion was reported in 17 studies (Estimated rates were 36.6%, 95% CI [18.4%-56.3%]; and 11.9%, 95%CI [6.6%-18.1%]; respectively).
CONCLUSIONS: Meta-analysis showed that although the overall risk of infection development is less than 10%, just below one third of the infected cases undergo late amputation. Moreover, internal fixation reconstructions carry a nonunion risk of just above 10%.
METHODS: We searched PubMed, Scopus and CENTRAL until the 17th of May 2022 for completed studies investigating outcomes following midfoot and/or hindfoot and/or ankle diabetic Charcot reconstruction. For a paper to qualify for inclusion, an internal fixation element should have been considered. Random effects meta-analysis of proportion was performed to calculate the rate of post-operative deep-seated infections with the associated amputation rate and nonunions by using Open Meta-analyst software. Sub-analysis linked to anatomical location of reconstruction was performed and the quality of the included studies was appraised using the Moga tool.
RESULTS: Thirty studies with 492 eligible reconstructions were considered. Of those, deep-seated infections were diagnosed in 46 cases (Estimated proportion was 6.7%, 95% CI [4.2%-9.2%]). Debridement and antibiotic administration with or without metalwork removal were considered in the majority of the participants with successful clinical outcomes. Amputation was performed in 15 patients due to unmanageable post-operative infection and nonunion was reported in 17 studies (Estimated rates were 36.6%, 95% CI [18.4%-56.3%]; and 11.9%, 95%CI [6.6%-18.1%]; respectively).
CONCLUSIONS: Meta-analysis showed that although the overall risk of infection development is less than 10%, just below one third of the infected cases undergo late amputation. Moreover, internal fixation reconstructions carry a nonunion risk of just above 10%.
摘要：
背景：鉴于关于神经性糖尿病患者感染金属制品和骨不连管理的文献很少，设计了一项荟萃分析,以研究通过内固定方法进行Charcot重建后的两种主要并发症.
方法：我们搜索了PubMed，Scopus和CENTRAL直到2022年5月17日完成研究，调查中足和/或后足和/或踝关节糖尿病Charcot重建后的结果。对于有资格入选的论文，应该考虑内固定元件。使用OpenMeta分析软件对比例进行随机效应荟萃分析，以计算术后深层感染的发生率以及相关的截肢率和不愈合率。进行与重建解剖位置相关的子分析，并使用Moga工具评估纳入研究的质量。
结果：考虑了30项研究，492项符合条件的重建。其中,46例诊断为深部感染(估计比例为6.7%，95%CI[4.2%-9.2%]）。在大多数具有成功临床结果的参与者中，考虑了清创术和抗生素施用，有或没有金属制品去除。由于手术后感染难以控制，15例患者进行了截肢，17项研究报告了不愈合(估计发生率为36.6%，95%CI[18.4%-56.3%]；和11.9%，95CI[6.6%-18.1%]；分别）。
结论：Meta分析显示，尽管感染发展的总体风险低于10%，略低于三分之一的感染病例接受了后期截肢。此外，内固定重建的骨不愈合风险略高于10%。
方法：我们搜索了PubMed，Scopus和CENTRAL直到2022年5月17日完成研究，调查中足和/或后足和/或踝关节糖尿病Charcot重建后的结果。对于有资格入选的论文，应该考虑内固定元件。使用OpenMeta分析软件对比例进行随机效应荟萃分析，以计算术后深层感染的发生率以及相关的截肢率和不愈合率。进行与重建解剖位置相关的子分析，并使用Moga工具评估纳入研究的质量。
结果：考虑了30项研究，492项符合条件的重建。其中,46例诊断为深部感染(估计比例为6.7%，95%CI[4.2%-9.2%]）。在大多数具有成功临床结果的参与者中，考虑了清创术和抗生素施用，有或没有金属制品去除。由于手术后感染难以控制，15例患者进行了截肢，17项研究报告了不愈合(估计发生率为36.6%，95%CI[18.4%-56.3%]；和11.9%，95CI[6.6%-18.1%]；分别）。
结论：Meta分析显示，尽管感染发展的总体风险低于10%，略低于三分之一的感染病例接受了后期截肢。此外，内固定重建的骨不愈合风险略高于10%。
