夏科氏足/踝关节病的最新研究进展

Research progress of Charcot neuroarthropathy

夏科氏足/踝关节病(Charcot neuroarthropathy,CN)是罕见的足踝部疾病,其发病与糖尿病密切相关。CN的病理生理尚未确定,目前研究认为炎症因子比例失衡是其主要的发病原因,以往有神经血管理论、神经创伤理论等。该病以关节破坏严重及活动受限为特点,其临床分型依据足踝部受累区域、影像学结果进行划分,其中改良的Eichenhohz分期在临床应用最广泛,有助于评估病情和指导治疗。夏科氏足/踝关节病的确诊需要临床表现结合影像学检查综合考虑,常规X线不能排除早期病变,应及时行CT、MRI等检查。根据临床分型,早期治疗方式主要包括非负重支具保护、短期内抗骨质吸收药物及手术治疗等,达到控制炎症、预防发生畸形和发生溃疡;对于晚期患者,根据患足受损具体情况采用一种或多种手术方式联合进行治疗,以恢复足部功能,避免截肢。本文通过对夏科氏足/踝关节病的病理生理、临床分类与表现、分型及治疗方法等方面的系统论述,为此类疾病在临床的诊断与治疗提供借鉴。

Charcot neuroarthropathy(CN)is a rare foot and ankle disease,which is closely related to diabetes.Its pathophysiology is not yet understood.The current study suggests that the imbalance of inflammatory factors is the main cause of its pathogenesis.In the past,there were neurovascular theory and neurotrauma theory.The disease is characterized by severe joint destruction and limited mobility.Its clinical classification is based on the affected area of the foot and ankle and imaging results.The modified Eichenhohz staging system is the most widely used in clinical practice,and is helpful in assessing the condition and guiding treatment.The diagnosis of Charcot neuroarthropathy requires a comprehensive review of clinical manifestations and imaging studies.Conventional X-ray cannot rule out early lesions,and CT and MRI should be performed in a timely manner.According to clinical classification,early treatment methods mainly include non-weightbearing brace protection,short-term anti-resorptive drugs and surgical treatment,etc.,to control inflammation and prevent deformity and ulceration;for patients with advanced stage,one or more surgical methods are combined according to the specific conditions of foot damage to restore foot function and avoid amputation.This article systematically discusses the pathophysiology,clinical classification and manifestations,classification and treatment methods of Charcot neuroarthropathy,and provides reference for clinical diagnosis and treatment of such diseases.