足踝部糖尿病夏科神经性关节病的临床诊治进展  

Progress in clinical diagnosis and treatment of diabetic Charcot neuroarthropathy of foot and ankle

作　　者：岳洋 冯慧 刘培珑 刘亮[2] 梁景棋 梁晓军[2] 赵宏谋[2] YUE Yang;FENG Hui;LIU Peilong;LIU Liang;LIANG Jingqi;LIANG Xiaojun;ZHAO Hongmou(Xi’an Medical University,Xi’an Shaanxi,710016,P.R.China;Department of Foot and Ankle Surgery,Honghui Hospital of Xi’an Jiaotong University,Xi’an Shaanxi,710054,P.R.China)

机构地区：[1]西安医学院,西安710016 [2]西安交通大学附属红会医院足踝外科,西安710054

出　　处：《中国修复重建外科杂志》2023年第11期1438-1443,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：西安市卫生健康委员会面上培育项目(2022ms07);陕西省重点研发计划项目(2021SF-025)。

摘　　要：目的 总结足踝部糖尿病夏科神经性关节病(Charcot neuroarthropathy,CNO)的临床诊治进展,为临床治疗提供参考。方法 广泛查阅国内外有关足踝部糖尿病CNO的研究文献,从CNO分期及分型标准、病程不同时期的治疗方法等方面进行总结。结果 CNO是一种因周围神经病变引起的骨关节急速破坏性疾病,因骨关节破坏和保护性感觉缺失导致局部畸形及应力性溃疡的形成,最终导致残疾甚至威胁患者生命。目前,临床常用的足踝部CNO分期标准是改良Eichenholtz分期,以临床和影像学表现分为4期;分型主要采用改良Brodsky分型,按解剖结构分为6型。足踝部糖尿病CNO治疗方法的选择需要结合分期、血糖、合并症、局部软组织条件、骨关节破坏程度、是否合并溃疡与感染等因素综合考虑。活动期主要采取保守治疗,稳定期主要采取手术治疗。结论 制定个体化、阶梯化治疗方案有助于提高足踝部糖尿病CNO疗效。但目前仍缺乏确切的临床证据对活动期与稳定期的治疗进行指导,未来需要进一步研究。Objective To summarize the progress of clinical diagnosis and treatment of diabetic Charcot neuroarthropathy(CNO)of foot and ankle to provide reference for clinical treatment.Methods The research literature on diabetic CNO of foot and ankle at home and abroad was widely reviewed,and the stages and classification criteria of CNO were summarized,and the treatment methods at different stages of the disease course were summarized.Results CNO is a rapidly destructive disease of bone and joint caused by peripheral neuropathy,which leads to the formation of local deformities and stress ulcers due to bone and joint destruction and protective sensory loss,which eventually leads to disability and even life-threatening.At present,the modified Eichenholtz stage is a commonly used staging criteria for CNO of foot and ankle,which is divided into 4 stages by clinical and imaging manifestations.The classification mainly adopts the modified Brodsky classification,which is divided into 6 types according to the anatomical structure.The treatment of diabetic CNO of foot and ankle needs to be considered in combination with disease stage,blood glucose,comorbidities,local soft tissue conditions,degree of bone and joint destruction,and whether ulcers and infections are present.Conservative treatment is mainly used in the active phase and surgery in the stable phase.Conclusion The formulation of individualized and stepped treatment regimens can help improve the effectiveness of diabetic CNO of foot and ankle.However,there is still a lack of definitive clinical evidence to guide the treatment of active and stable phases,and further research is needed.

关 键 词：夏科神经性关节病 糖尿病 足踝部 保守治疗 手术治疗 

分 类 号：R658.3[医药卫生—外科学]