Peripheral Vascular Disease Diagnostic Related Outcomes in Diabetic Charcot Reconstruction
Peripheral Vascular Disease Diagnostic Related Outcomes in Diabetic Charcot Reconstruction
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DOI：
10.1053/j.jfas.2019.06.002
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发表时间：
2019-11-01
影响因子：
1.3
通讯作者：
Kim, Paul J.
中科院分区：
文献类型：
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作者：
Cates, Nicole K.;Elmarsafi, Tammer;Kim, Paul J.
比较了血管造影诊断为外周动脉疾病（PAD）的糖尿病Charcot神经关节病（CN）患者与临床诊断患者的重建后结局。对继发于溃疡和/或急性感染需要重建的糖尿病CN患者进行了回顾性分析。在CN骨重建队列的284例患者中，考虑排除标准后，59例（20.8%）PAD患者纳入分析。在这59例患者中，40例（67.8%）临床诊断为PAD，19例（32.2%）通过血管造影诊断。使用双变量分析比较通过血管造影诊断为PAD的患者与临床诊断为PAD的患者的以下重建后结局：伤口愈合、延迟愈合、手术部位感染、针道感染、骨髓炎、裂开、转移溃疡、新的Charcot塌陷部位、对侧Charcot事件、骨不连、下肢大截肢和恢复截肢。双变量分析发现，重建后恢复至Amplitude（p = 0.0054）是唯一具有统计学意义的因素。下肢大截肢有显著性趋势，临床诊断PAD组截肢率较高，恢复截肢表明功能结局改善。保肢手术的主要目标应集中在改善患者的功能表现上。由于恢复截肢率明显更快，大截肢率呈下降趋势，血管造影术被认为是比临床评估更好的PAD评估方法。(C)2019年由美国足部和踝关节外科医生学院。All rights reserved.
Postreconstructive outcomes were compared in diabetic patients with Charcot neuroarthropathy (CN) who had peripheral arterial disease (PAD) diagnosed with angiography versus patients who were diagnosed clinically. A retrospective review was performed of patients with diabetic CN requiring reconstruction secondary to ulceration and/or acute infection. Of the 284 patients in the CN osseous reconstruction cohort, after accounting for exclusion criteria, 59 (20.8%) patients with PAD were included in the analyses. Forty (67.8%) of these 59 patients were diagnosed with PAD clinically and 19 (32.2%) were diagnosed with the use of angiography. Bivariate analysis was used to compare outcomes between those diagnosed with PAD via angiography versus those diagnosed clinically for the following postreconstruction outcomes: wound healing, delayed healing, surgical site infection, pin tract infection, osteomyelitis, dehiscence, transfer ulcer, new site of Charcot collapse, contralateral Charcot event, nonunion, major lower extremity amputation, and return to ambulation. Bivariate analysis found return to ambulation postreconstruction (p = .0054) to be the only statistically significant factor. There was a trend toward significance for major lower extremity amputation, with higher rates of amputation in the clinically diagnosed PAD arm. Return to ambulation indicates improved functional outcomes. The main goal of limb salvage should be focused on improving the patient's functional performance. With significantly faster rates of return to ambulation and a trend toward decreased rates of major amputation, angiography was found to be a better assessor of PAD than clinical evaluations. (C) 2019 by the American College of Foot and Ankle Surgeons. All rights reserved.