Abstract：
The aim of this paper is to review the recent literature regarding the epidemiology and surgical management of Charcot neuro-osteoarthropathy (CNO). We propose that a fundamental change in the approach and assumptions regarding the historical treatment of active CNO should be considered. Although the true incidence and prevalence of CNO in the US population with diabetes are not known, we estimated the incidence to be 27,602 per year and the prevalence to be 208,880 persons. In persons with diabetes, the incidence of CNO is higher than that of prostate, lung, kidney, and thyroid cancer, and in the entire US population, the incidence of CNO is higher than that of multiple myeloma, soft tissue sarcoma, and primary bone sarcoma. In persons with diabetes, the incidence of CNO is higher than fractures of the femoral shaft, distal femur, tibia, talus, calcaneus and Lisfranc ligament injuries. Surgical techniques have evolved over the past half century, and surgery is the standard for treating displaced fractures and intra-articular injuries. Since CNO is a fracture, dislocation, or fracture dislocation in patients with neuropathy, why do we treat CNO differently? Elsewhere in the skeleton displaced osseous and ligament injuries are treated surgically. Based on the information presented in this manuscript, we suggest that it is time for a paradigm shift in the treatment of persons with CNO. While uncommon, CNO in persons with diabetes is not rare. Given the advances in surgical techniques, surgical intervention should be considered earlier in persons with CNO who are at risk for developing deformity related foot ulceration.
摘要：
本文的目的是回顾有关Charcot神经骨关节病（CNO）的流行病学和外科治疗的最新文献。WeproposethatafundamentalchangeintheapproachandassumptionsregardingthehistoricaltreatmentofactiveCNOshouldbeconsidered.尽管CNO在美国糖尿病人群中的真实发病率和患病率尚不清楚，我们估计每年的发病率为27,602人,患病率为208,880人.在糖尿病患者中，CNO的发病率高于前列腺，肺，肾,甲状腺癌，在整个美国人口中，CNO的发病率高于多发性骨髓瘤，软组织肉瘤,和原发性骨肉瘤.在糖尿病患者中，CNO的发生率高于股骨干骨折，股骨远端,胫骨,距骨,跟骨和Lisfranc韧带受伤.手术技术在过去的半个世纪中不断发展，手术是治疗移位骨折和关节内损伤的标准。由于CNO是骨折,位错,或神经病患者的骨折脱位，为什么我们对待CNO不同？在骨骼的其他地方，移位的骨和韧带损伤都是通过手术治疗的。根据这份手稿提供的信息，我们建议，现在是时候对患有CNO的人进行范式转变了。虽然不常见，CNO在糖尿病患者中并不罕见。鉴于手术技术的进步，对于有发生畸形相关足部溃疡风险的CNO患者,应尽早考虑手术干预.
