背景:Charcot神经关节病(Charcotfoot)是一种高度破坏性的足和踝关节疾病。如果有延误的诊断和治疗,会导致严重畸形,不稳定性,复发性溃疡和/或截肢。完全接触铸造(TCC)是一种常用的治疗方法,用于固定脚和脚踝以防止创伤,在炎症阶段进一步破坏并保留足部结构。目前,澳大利亚关于TCC治疗急性Charcot足的持续时间的数据有限,以及是否有任何患者和临床因素影响其持续时间。因此,本研究旨在解决这些不足。
方法:本研究对27例急性Charcot足患者进行回顾性分析,在墨尔本的一个大城市健康网络中,接受高风险足服务(HRFS)的TCC治疗。澳大利亚。在三年的时间里,通过回顾临床的医院病历来回顾性收集数据,人口统计学,医学成像和足部检查信息。为了探索群体之间的差异,独立样本t检验,Mann-WhitneyU测试,卡方检验,和/或Fisher的精确检验是根据数据类型计算的。为了评估记录变量与TCC治疗持续时间之间的关联,平均差异,计算比值比(OR)和95%置信区间.
结果:平均年龄为57.9岁(SD,12.6)年,66.7%为男性,88.9%患有糖尿病,96.3%有周围神经病变,33.3%患有外周动脉疾病。63.0%的参与者出现Charcot误诊,与急性沙科足一致的体征和症状中位数为2.0(IQR,1.0至6.0)在提交或提交HRFS之前的几个月。所有参与者都有第一阶段的Charcot脚。其中,大多数患者位于睑板关节(44.4%)或中足(40.7%),并由溃疡或外伤引发(85.2%).急性Charcot足消退的TCC持续时间中位数为4.3(IQR,2.7至7.8)个月,每个石膏的总并发症率为5%。皮肤摩擦/刺激(40.7%)和不对称疼痛(22.2%)是最常见的TCC并发症。骨关节炎与TCC持续时间超过4个月(OR,6.00).TCC后处理,48.1%的人使用定制足部矫形器回归鞋类,25.9%使用了终身Charcot约束矫形器,22.2%接受软组织或骨重建手术。没有Charcot复发,然而,3例(11.1%)参与者发生对侧Charcot.
结论:急性Charcot足消退的TCC持续时间中位数为4个月,与英国报告的数据更短或相当,美国,欧洲,和其他亚太国家。骨关节炎与更长的TCC持续时间显着相关。这项研究的结果可能有助于临床医生提供患者教育,澳大利亚急性Charcot神经关节病病例的管理期望和改善TCC治疗的依从性。
BACKGROUND: Charcot neuroarthropathy (Charcot foot) is a highly destructive joint disease of the foot and ankle. If there is delayed diagnosis and treatment, it can lead to gross deformity, instability, recurrent ulceration and/or amputation. Total contact casting (TCC) is a treatment commonly used to immobilise the foot and ankle to prevent trauma, further destruction and preserve the foot structure during the inflammatory phase. At present, there is limited Australian data regarding the duration of TCC treatment for resolution of acute Charcot foot, and whether there are any patient and clinical factors affecting its duration. Therefore, this
study aimed to address these deficiencies.
METHODS: This
study presents a retrospective analysis of 27 patients with acute Charcot foot attending for TCC treatment at a high-risk foot service (HRFS) in a large metropolitan health network in Melbourne, Australia. Over a three-year period, data were retrospectively collected by reviewing hospital medical records for clinical, demographic, medical imaging and foot examination information. To explore between-group differences, independent samples t-tests, Mann-Whitney U tests, Chi-square tests, and/or Fisher\'s exact tests were calculated depending on data type. To evaluate associations between recorded variables and duration of TCC treatment, mean differences, odds ratios (OR) and 95% confidence intervals were calculated.
RESULTS: Mean age was 57.9 (SD, 12.6) years, 66.7% were male, 88.9% had diabetes, 96.3% had peripheral neuropathy, and 33.3% had peripheral arterial disease. Charcot misdiagnosis occurred in 63.0% of participants, and signs and symptoms consistent with acute Charcot foot were present for a median of 2.0 (IQR, 1.0 to 6.0) months prior to presenting or being referred to the HRFS. All participants had stage 1 Charcot foot. Of these, the majority were located in the tarsometatarsal joints (44.4%) or midfoot (40.7%) and were triggered by an ulcer or traumatic injury (85.2%). The median TCC duration for resolution of acute Charcot foot was 4.3 (IQR, 2.7 to 7.8) months, with an overall complication rate of 5% per cast. Skin rubbing/irritation (40.7%) and asymmetry pain (22.2%) were the most common TCC complications. Osteoarthritis was significantly associated with a TCC duration of more than 4 months (OR, 6.00). Post TCC treatment, 48.1% returned to footwear with custom foot orthoses, 25.9% used a life-long Charcot Restraint Orthotic Walker, and 22.2% had soft tissue or bone reconstructive surgery. There were no Charcot recurrences, however, contralateral Charcot occurred in 3 (11.1%) participants.
CONCLUSIONS: The median TCC duration for resolution of acute Charcot foot was 4 months, which is shorter or comparable to data reported in the United Kingdom, United States, Europe, and other Asia Pacific countries. Osteoarthritis was significantly associated with a longer TCC duration. The findings from this
study may assist clinicians in providing patient education, managing expectations and improving adherence to TCC treatment for acute Charcot neuroarthropathy cases in Australia.