膝关节Charcot关节病六例误诊分析  

Misdiagnosis Analysis of Six Cases of Charcot’s Arthropathy of Knee Joint

作　　者：亢军强 刘洋 步子恒 KANG Jun-qiang;LIU Yang;BU Zi-heng(Department of Orthopedics,the 990th Hospital of PLA Joint Logistics Support Forces,Xinyang,Henan 464000,China;Department of Joint Osteopathy,Changhai Hospital,Shanghai 210000,China)

机构地区：[1]中国人民解放军联勤保障部队第九九○医院信阳院区骨科,河南信阳464000 [2]长海医院关节骨病外科,上海210000

出　　处：《临床误诊误治》2020年第5期17-21,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨膝关节Charcot关节病临床特点及误诊原因、防范措施。方法回顾性分析膝关节Charcot关节病18例中首诊误诊6例的临床资料。结果本组误诊率为33.33%。6例分别因双膝关节反复无力、走路跌倒,膝关节活动后酸胀,右膝关节活动后卡顿、自觉关节内有硬块,反复发作右膝关节肿胀伴无力,以及双膝关节轻度不适就诊。3例中年女性分别误诊为双膝关节类风湿性关节炎、右膝结核性关节炎和右膝关节滑膜炎,3例老年患者均误诊为双膝关节退行性骨关节炎。6例初步诊断后均按误诊疾病采用相应保守治疗,但效果不佳。误诊时间3~12(7.1±3.2)个月。后6例均结合病史、临床表现及实验室、影像学检查结果确诊膝关节Charcot关节病。除1例确诊后未选择在本院治疗;5例均行手术治疗,皆病情好转后出院,出院后随访3~12(8.8±2.9)个月,膝关节功能均恢复。结论膝关节Charcot关节病患者早期缺乏特异性临床表现,易误诊;晚期破坏性极强,对患者生活质量影响很大。临床医生应提高对其警惕性,加强对其早期临床表现及影像学检查结果的认识和了解,以减少或避免该病误诊误治。Objective To investigate the clinical characteristics, causes of misdiagnosis and preventive measures of Charcot’s arthropathy of knee joint. Methods The clinical data of 6 out of 18 patients with Charcot’s arthropathy of the knee joint who were misdiagnosed at initial visit were retrospectively analyzed. Results The misdiagnosis rate was 33.33%. Six cases presented with repeated knee weakness, walking and falling, swelling after knee joint movement, stagnation after movement of the right knee, self-reported lumps in the joints, repeated swelling of the right knee joint with knee weakness, and mild discomfort of both knees. Three female patients were misdiagnosed as rheumatoid arthritis of both knees, tuberculous arthritis of the right knee and synovitis of the right knee, respectively. All 3 elderly patients were misdiagnosed as degenerative osteoarthritis of both knees. Conservative treatment was ineffective according to misdiagnosed disease in all 6 cases after initial diagnosis. The time of misdiagnosis ranged from 3-12(7.1±3.2) months. The latter 6 cases were diagnosed with Charcot’s arthropathy of knee joint by combining medical history, clinical manifestations and laboratory and imaging findings. One patient was not treated in our hospital after diagnosis, and 5 patients underwent surgical treatment and were discharged after their conditions were improved. The knee joint function recovered at 3-12(8.8±2.9) months of follow-up after discharge. Conclusion Charcot’s arthropathy of the knee lacks specific clinical manifestations in the early stage, which is, therefore, more likely to be misdiagnosed. The late stage is extremely destructive and has a great impact on the quality of life of patients. Clinicians should improve their vigilance and enhance their understanding of early clinical manifestations and imaging findings, to reduce or avoid misdiagnosis and mistreatment of the disease.

关 键 词：关节病 神经原性 误诊 关节炎 类风湿 结核 骨关节 滑膜炎 

分 类 号：R684[医药卫生—骨科学]