神经营养性骨关节病(附111例分析)

NEUROTROPHIC OSTEOARTHROPATHY(REPORT OF 111 CASES)

报告111例(159处关节)神经营养性骨关节病的临床 X 线观察结果,并对其主要临床表现和典型 X 线征象以及各不同关节的 X 线改变作了分析。根据下列事实,讨论了 Charcot 关节的发病机理:①肩部的 Charcot,不仅关节甚至整个肩胛骨均可瓦解;②关节清除和关节固定术后,两骨端及骨干侧面又出现新的骨破碎;③关节面或软骨下的破损可见于非持重或非接触面;④有32例既无外伤又无特别活动而发生病理骨折;⑤短期内(2～6周)随访发现进行性破坏发展迅速。因此,Charcot 关节的形成不能单独用创伤理论解释,必然有一潜在的骨内病变。神经营养理论应当是 Charcot 关节重要的发病机理。因该理论能够充分解释 X 线的所有改变。作者认为“吸收”应当是 Charcot 关节在骨内的原发改变,而增生肥大等则为继发改变。

The clinical and radiological observations of 111 patients(159 joints)with neurotrophic osteoarthropathy are presented.The main clinical and typical X-ray findings as well as the radiologic features of different joints are described. The pathogenesis of Charcot joint in our series are specially discussed on the basis of following facts:(1)The shoulder charcot,not only the joint,but also the entire scapula bone,might be disintegrated;(2)After cleaning and arthrodesis, both ends of distroyed long bone and even the lateral suface of diaphysis showed new desintegration again;(3)Fragmentation of articular surfaces or subchondrall areas might be seen in non.contact non-burden surfaces;(4)32 cases of our series presented with spontaneous factures occurred without a history of trauma or unusual activity;(5)Follow-up observation within short periods(two to six weeks)revealed rapid progressive destruction.Many of our observations mentioned above cannot be explained by aeurotraumatic pathogenesis alone.There must be an underlying bone abnormality.We consider that the neurotrophic theory should be the important pathogenesis of the Charcot joint.Because this pathogenesis is suffi- cient in explaining all the changes radiographically.We believe that bone resorption should be the primary change while the hypertrophic change or proliferation is secondary one.