Charcot

夏科
  • 文章类型: Journal Article
    Charcot关节病是一种进行性疾病,非传染性,通常影响脚和脚踝的破坏性和衰弱性。本系统综述旨在评估与中足Charcot神经关节病的每种干预措施相关的常见结局的发生。
    收集了2010年1月至2020年1月发表的文献的系统综述,回顾并选择了有关中足Charcot神经关节病的手术治疗方法。
    初始搜索产生了231个报告,排除后,所有研究中有9项纳入了结局分析,以供回顾.这些研究包括有关中足Charcot关节病手术重建的数据。
    建议软组织制备和使用植入物的组合,从而降低感染的风险,并增加结构的刚度,分别。这些因素将有助于改善中足Charcot关节病重建的结果。
    UNASSIGNED: Charcot arthropathy is a condition which is progressive, non-infectious, destructive and debilitating that commonly affect foot and ankle. This systematic review is to evaluate the occurrence of common outcomes associated with each intervention of Charcot neuroarthropathy in midfoot.
    UNASSIGNED: A systematic review on literatures that were published from Jan 2010 to Jan 2020 were collected, reviewed and selected regarding the surgical treatment procedures of Charcot neuroarthropathy in midfoot.
    UNASSIGNED: The initial search yielded 231 reports and after exclusion, nine out of the total studies were included in the outcome analysis for review. These were studies that included data concerning surgical reconstruction of Charcot arthropathy in the midfoot.
    UNASSIGNED: It is suggested that soft tissue preparation and usage of combination of implants thus reduce the risk of infection as well as increase rigidity of construct, respectively. These factors will aid to improve outcome of midfoot Charcot arthropathy reconstruction.
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  • 文章类型: Journal Article
    目的:对侧温度差(CTD)是Charcot神经关节病(CNA)治愈的常用标志。我们旨在确定在愈合过程中是否有一致的CTD测量方法以及停止固定的决策过程。
    方法:Medline,Scopus,和WebofScience搜索到2022年2月的同行评审研究,使用关键词包括((“关节病”或“骨关节病”或“骨病”或“神经关节病”)和“Charcot”和(“温度”)),它返回了789个结果,不包括重复项。纳入的研究监测了具有活性CNA的CTD,以(i)评估愈合过程;或(ii)协助确定从固定的过渡。
    结果:总共有34项研究(n=677名参与者)入围,19项经全篇论文综述后纳入。呈现时的平均CTD在1.6-8.0°C之间变化,没有足够的数据来确定CTD是否与Charcot的严重程度成比例。CTD与基于射线照相或闪烁显像的愈合标志物之间关系的证据取决于所采用的方法。停止固定的阈值CTD范围为<1°C至<2°C。最常见的是<2°C持续2-3次访问。在足休息15分钟后,通常每2-6周使用手持测温法在CNA部位监测温度。设备类型,准确性/可靠性,和环境温度很少报告。
    结论:需要对CTD和放射学和放射性示踪剂标志物进行进一步研究,涉及更大的队列。报告测温设备类型时的标准化,准确性和可靠性,脚的休息时间和环境温度的控制是必要的,以促进比较的研究,不同固定干预措施的荟萃分析和评价。本文受版权保护。保留所有权利。
    Contralateral temperature difference (CTD) is a frequently used marker of healing in Charcot neuro-osteoarthropathy (CN). We aimed to determine whether there is a consistent approach to CTD measurement during healing and the decision-making process around cessation of immobilisation.
    Medline, Scopus, and Web of Science were searched until February 2022 for peer-reviewed studies using keywords, including ((\'arthropathy\' OR \'osteoarthropathy\' OR \'osteopathy\' OR \'neuroarthropathy\') AND \'Charcot\' AND (\'temperature\')), which returned 789 results excluding duplicates. Included studies monitored CTD in those with active CN to (i) assess the healing process and (ii) assist in determining the transition from immobilisation.
    Thirty four studies in total (n = 677 participants) were shortlisted and 19 were included after full paper review. Average CTD at presentation varied from 1.6 to 8.0°C with insufficient data to determine if CTD was proportional to severity of Charcot. Evidence of a relationship between CTD and radiographic or scintigraphy-based markers of healing varied depending on the methodology employed. Threshold CTD for the cessation of immobilisation ranged from <1°C to <2°C. Most frequently it was <2°C sustained for 2-3 visits. Temperature was monitored typically every 2-6 weeks using handheld thermometry at CN site(s) after resting the feet for 15 min. Device type, accuracy/reliability, and ambient temperature were rarely reported.
    Further research on CTD and radiographic and radiotracer markers is needed involving larger cohorts. Standardisation in reporting of thermometry device type, accuracy and reliability, foot resting times, and ambient temperature controls is essential to facilitate the comparison of studies, meta-analysis, and evaluation of different immobilisation interventions.
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  • 文章类型: Systematic Review
    未经证实:Charcot踝关节和后足神经关节病是一种复杂的临床实体,截肢风险很高。Charcot神经关节病的肢体重建已被提议作为肢体挽救程序。然而,缺乏有关各种可用重建方法的信息,包括结果和并发症。本研究旨在评估当前文献,并更新有关踝关节和后足Charcot神经关节病的手术治疗趋势。
    UNASSIGNED:分析了2010年1月至2020年1月发表的所有数据,这些数据调查了Charcot神经关节病手术重建的固定方法及其各自的结果。工会率,截肢率,并对与这些技术相关的并发症进行统计分析.
    未经评估:共有16项研究符合本研究的纳入标准,纳入了4项III级研究和12项IV级研究.10项研究仅使用内固定;5项使用内固定和圆形外固定器的组合,在内部和外部固定之间有三个比较研究,两项研究应用了内外固定联合技术(混合固定)。一项研究仅描述了圆形外固定架的使用。
    UASSIGNED:在Charcot踝关节病的重建中,建议在溃疡发生之前使用逆行髓内钉作为首选治疗方法。建议将羟基磷灰石(HA)涂层螺钉用于锁定机制,以防止由于骨骼质量差而在Charcot神经关节病中迁移。建议在溃疡和更复杂的畸形情况下进行混合固定,因为它可以提供更高的肢体抢救率,而软组织刺激更少。
    UNASSIGNED: Charcot neuroarthropathy of the ankle and the hindfoot is a complex clinical entity with a high risk of amputation. Charcot neuroarthropathy limb reconstruction has been proposed as a limb-salvaging procedure. However, there was a lack of information on the various available reconstruction methods, including the outcomes and complications. The present study aimed to evaluate the current literature and update on the trends regarding the surgical management of Charcot neuroarthropathy of the ankle and the hindfoot.
    UNASSIGNED: All data published from January 2010 to January 2020 that investigated the methods of fixation and their respective outcomes for the surgical reconstruction in Charcot neuroarthropathy were analyzed. The union rate, amputation rates, and complications associated with these techniques were taken for statistical analysis.
    UNASSIGNED: A total of 16 studies fit the inclusion criteria of this study, with four Level-III studies and 12 Level-IV studies were included. Ten studies utilized internal fixation only; five used a combination of internal fixation and circular external fixator, whereby there are three comparative studies between internal and external fixations, and two studies applied combined technique of internal and external fixations (hybrid fixation). One study describes the usage of circular external fixation only.
    UNASSIGNED: The use of retrograde intramedullary nail as a treatment of choice in the reconstruction of Charcot neuroarthropathy ankle is recommended before an ulcer occurrence. Hydroxyapatite (HA)- coated screws are recommended for the locking mechanism to prevent migration in Charcot neuroarthropathy due to poor bony quality. Hybrid fixation is recommended for reconstruction in a condition of ulceration and more complex deformity as it provides a higher rate of limb salvage with less soft tissue irritation.
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  • 文章类型: Case Reports
    The Charcot knee is a progressive, degenerative disease of the joint that may represent a diagnostic challenge; at the moment, poorly controlled diabetes mellitus is the main cause of this condition. We describe here a case of a man presenting with an end stage joint arthropathy who was diagnosed with neurosyphilis. Tabetic arthropathy is currently a very rare disease, but in the past represented the main cause of joint arthropathy. Finally, we discussed the different surgical options of Charcot arthropathy, our choice of megaprosthesis implant and the failure of such procedure mainly due to patient\'s unreliability to care leading to infective complications and peri-prosthesis fracture.
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  • 文章类型: Journal Article
    Total knee arthroplasty (TKA) is an effective procedure to treat many patients with end-stage knee arthropathy. However, the extension of TKA for patients with Charcot neuroarthropathy (CNA) is controversial, with relatively limited evidence defining optimal reconstruction techniques.This systematic review of relevant studies that were published from January 2000 to June 2020 aimed to define survivorship, complications, reoperation, and component revision rates of contemporary TKA performed for CNA.We identified 127 TKA performed for CNA in five studies that comprised ≥ 7 knees with ≥ 5 years of follow-up.Overall implant survivorship was 85.4%. The overall complication rate was 26.4%, with the most common complications including instability (24.0%), periprosthetic fracture (17.4%), infection (13.0%), ligament injury (10.9%) and aseptic loosening (10.9%).The aetiology of CNA and prosthesis type had no influence on clinical outcomes, whereas the effect of staging of disease and ataxia status was still inconclusive.Understanding the potential determinants, survivorship and risk of complications related to TKA performed in CNA may help surgeons to deal with patient expectations. Cite this article: EFORT Open Rev 2021;6:556-564. DOI: 10.1302/2058-5241.6.200103.
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  • 文章类型: Journal Article
    背景:急性Charcot神经关节病(CN)是一种破坏性疾病,以急性骨折为特征,错位和关节破坏在承重脚。急性期经常被误诊,并可能迅速导致破坏性的健康结果。CN的早期诊断和治疗对于减轻这种疾病的进展至关重要。因此,及时的循证评估,急性CN的诊断和治疗势在必行。
    目的:确定评估中影响循证护理提供的因素,急性CN患者的诊断和治疗。
    方法:在四个数据库中进行了系统搜索,以确定在评估中包括影响循证护理提供的因素的英文研究。急性CN患者的诊断和治疗。研究人员对文章和共识/指南文件进行了评估,并通过共识解决了分歧。此外,反向引用搜索用于获取其他可能相关的文档。提取了与研究问题相关的信息,并使用定性综合进行了主题分析。
    结果:纳入了32篇文章和4篇其他共识/指南文件,用于数据提取和分析。与研究问题相关的信息是使用国家健康与医学研究委员会(NHMRC)证据水平指南的专家意见。主题解释了在评估中偏离循证护理的实践,以患者为中心的急性CN的诊断和管理,健康专业和健康组织/环境。延迟诊断尤其受到患者何时寻求帮助的知识的影响。从业者知识,知道如何识别和转介适当的即时护理,成像和卸载以及地理和当地卫生服务资源方面的混乱,以适当地管理病情。
    结论:个人和健康专业意识和地理障碍是有效提供循证评估的关键挑战,急性CN患者的诊断和治疗。急性CN代表一种医疗紧急情况,需要快速评估,由经过适当培训的卫生专业人员进行诊断和管理。
    BACKGROUND: Acute Charcot Neuroarthropathy (CN) is a destructive condition that is characterised by acute fractures, dislocations and joint destruction in the weight-bearing foot. The acute phase is often misdiagnosed and can rapidly lead to devastating health outcomes. Early diagnosis and management of CN is imperative to attenuate progression of this condition. Consequently, timely evidence-based assessment, diagnosis and management of acute CN is imperative.
    OBJECTIVE: To identify the factors that impact the delivery of evidence-based care in assessment, diagnosis and management of people with acute CN.
    METHODS: Systematic searches were conducted in four databases to identify studies in English that included factors that impact the delivery of evidence-based care in the assessment, diagnosis and management of people with acute CN. Articles and consensus/guideline documents were assessed for inclusion by the researchers and disagreements were resolved through consensus. Additionally backward citation searching was used to source other potentially relevant documents. Information relevant to the research question was extracted and thematic analyses were performed using qualitative synthesis.
    RESULTS: Thirty-two articles and four additional consensus/guideline documents were included for data extraction and analyses. Information related to the research question was of expert opinion using the National Health and Medical Research Council (NHMRC) Levels of Evidence guidelines. Themes explaining practices that deviated from evidence-based care in assessment, diagnosis and management of acute CN centred around patient, health professional and health organisation/environmental. Delay to diagnosis is particularly influenced by the patient\'s knowledge of when to seek help, practitioner knowledge in knowing how to recognise and refer for appropriate immediate care, confusion in imaging and offloading and geographical and local health service resources to appropriately manage the condition.
    CONCLUSIONS: Individual and health professional awareness and geographical barriers are key challenges to the effective delivery of evidence-based assessment, diagnosis and management of people with acute CN. Acute CN represents a medical emergency warranting the need for expedited assessment, diagnosis and management by appropriately trained health professionals in the appropriate.
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  • 文章类型: Journal Article
    UNASSIGNED: Ankle fractures in diabetic patients are known to have an increased morbidity. This systematic review aims to evaluate the current evidence in terms of risk profile and inform treatment options.
    UNASSIGNED: Following the methodology of the Cochrane collaboration, an extensive literature search was conducted. Outcomes included, complications, operative and non-operative management and early weight-bearing.
    UNASSIGNED: A total of 40 studies were included. Complication rates were higher in diabetic patients and more so in poorly controlled diabetes, IDDM, or \"complicated\" diabetes. Supplementary fixation was associated with lower complication rates. Regarding early weight-bearing, similar results to non-diabetics in the stable fracture pattern were found providing there was no evidence of neuropathy.
    UNASSIGNED: Diabetes, especially complicated diabetes, presents an increased risk of complications. However non operative management of diabetic ankle fractures do poorly, and with the use of \'ORIF plus\' techniques there is no increase in complications from early fixation. The use of external fixation for definitive fixation should be minimised as it is associated with high complication rates.
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  • 文章类型: Journal Article
    传统上,足中部的Charcot神经关节病(CN)是在完全接触石膏(TCC)中进行非手术减载治疗。在引入超级构造概念之后,报告了有希望的结果,然而,有必要进一步研究这个概念。介绍了非手术与手术治疗的分析,以及我们从连续20例采用超结构概念手术的患者中获得的结果。
    从2017年7月至2020年6月对20例患者进行了手术。平均年龄为58岁(50-80岁),平均体重为116公斤(68-156),BMI为31(26-45)。术前患者在TCC中卸载,直到肿胀和皮肤温度测量或溃疡愈合为止,平均16周固定。手术没有止血带,使用标准的内侧和外侧切口。平均随访24(5-40)个月。
    平均手术时间为227(150-315)分钟。内侧柱融合是强制性的,在五个案例中,作为一个孤立的程序,12例结合侧柱融合,3例结合距骨融合。术前外侧米里角由23.5°减小至9.6°,前后迈里角从16.0°减小到4.7°。八名患者有术后切口问题。四名患者进行了部分植入物移除。均痊愈,临床效果良好。两名患者在术后动员期间踝关节发生急性Charcot发作。一个人的距骨严重塌陷,导致膝盖以下截肢,给予5%的截肢率。随访时的射线照相检查,所有患者均显示骨愈合。最新随访时,有19名患者穿着矫形鞋被送往医院,给出了95%的满意结果。
    超结构重建CN中足塌陷是一个安全的程序。有切口问题,识别和快速治疗这些并发症对于取得良好的效果很重要。脚踝有超载的风险,发起新的急性Charcot发作.必须注意这个问题。手术技术要求很高,应由经验丰富的足踝外科医生在多学科团队中进行。
    UNASSIGNED: Charcot neuroarthropathy (CN) of the midfoot was traditionally treated non-operatively with off-loading in a total contact cast (TCC). After introduction of the super construct concept, promising results were reported, however there is a need for further studies on this concept. Analysis of non-operative versus operative treatment is presented as well as our results from a consecutive series of 20 patients operated with the superconstruct concept.
    UNASSIGNED: Twenty patients were operated from July 2017 until June 2020. Mean age was 58 years (50-80), mean weight was 116 kg (68-156), giving a BMI of 31 (26-45). Preoperative patients off-loaded in a TCC until decreased swelling and skin temperature measurement or ulcer had healed, mean 16 weeks immobilization. Surgery was without tourniquet, using a standard medial and lateral incision. Mean follow up is 24 (5-40) months.
    UNASSIGNED: Mean operation time was 227 (150-315) minutes. Medial column fusion was mandatory, in five cases as an isolated procedure, in 12 cases in combination with lateral column fusion and in three cases with a talocalcaneal fusion. Preoperative lateral Meary angle decreased from 23.5 to 9.6°, antero-posterior Meary angle decreased from 16.0 to 4.7°. Eight patients had postoperative incisional wound problems. Four patients had partial implant removal. All healed with a good clinical result. Two patients had an acute Charcot attack in the ankle joint during postoperative mobilization. One had a severe collapse of the talus resulting in a below knee amputation, giving an amputation rate of 5%. Radiographic examination at follow up, showed bone union of all patients. Nineteen patients are ambulated in orthopedic shoes at latest follow up, giving a 95% satisfactory result.
    UNASSIGNED: Superconstruct reconstruction of CN midfoot collapse is a safe procedure. There are incisional wound problems, recognition and fast treatment of these complications is important to achieve good results. There is a risk for overloading the ankle, initiating a new acute Charcot attack. Attention must be on this problem. The surgical technique is demanding and should be performed by experienced foot and ankle surgeons in a multidisciplinary team set up.
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  • 文章类型: Journal Article
    The Charcot foot is a condition characterized by a progressive derangement of the foot. The type of deformity and patient clinical conditions will lead to the proper surgical approach among exostectomy, arthrodesis (through external and/or internal fixation) and amputation. Many authors report good clinical outcomes performing the arthrodesis in Charcot foot; however, the choice of the most appropriate hardware is still an issue. The aim of this study is to analyze the outcomes of different hardware in midfoot and hindfoot Charcot arthrodesis.
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  • 文章类型: Journal Article
    背景:Charcot神经关节病是一种以进行性畸形为特征的复杂疾病,有限的治疗选择和高截肢率。已经提出了Charcot脚的外科重建作为一种保留脚的方法。然而,关于可用的不同重建方法的信息有限,结果和并发症。
    方法:我们系统分析了1993年1月至2018年12月发表的数据,以评估Charcot神经关节病手术重建的固定方法和相关结果。进行统计分析以确定截肢率,回到与这些技术相关的步行和并发症。
    结果:据报道,共有1116英尺(1089名患者)接受了重建,患者选择具有显着的异质性。其中,726人(65%)接受内固定,346英尺(31%)外固定和44(4%)同时进行内部和外部固定。没有一种技术比另一种技术具有明显的优势。总的来说,骨融合率为86.1%。在36%的个体中发现了直接归因于所采用技术的并发症。报道的重建后截肢率仅为5.5%,其中91%显然恢复了步行。
    结论:尽管没有确定首选的固定方法,我们发现,目前的手术重建方案可以在高度选择的人群中提供较低截肢风险的肢体抢救.然而,缺乏对照研究,不一致的结局报告和患者选择的异质性意味着证据质量较低.
    BACKGROUND: Charcot neuroarthropathy is a complex condition characterised by progressive deformity, limited treatment options and a high amputation rate. Surgical reconstruction of Charcot foot has been proposed as a method to preserve the foot. However, limited information exists on the different methods of reconstruction available, their outcomes and complications.
    METHODS: We systematically analysed published data from Jan 1993 to Dec 2018 to assess methods of fixation and associated outcomes for the surgical reconstruction in Charcot neuroarthropathy. Statistical analyses were undertaken to determine the amputation rates, return to ambulation and complications associated with these techniques.
    RESULTS: A total of 1116 feet (1089 patients) were reported to have undergone reconstruction with significant heterogeneity in patient selection. Of these, 726 (65%) were reported to undergo internal fixation, 346 feet (31%) external fixation and 44 (4%) undergoing simultaneous internal and external fixation. No single technique demonstrated a significant benefit over the other. Overall, the bone fusion rate was 86.1%. Complications directly attributable to the technique employed were noted in 36% of individuals. The reported post-reconstruction amputation rate was only 5.5% with 91% apparently returning to ambulation.
    CONCLUSIONS: Although no preferential method of fixation was identified, we find that the current options for surgical reconstruction could offer limb salvage with a low amputation risk in a highly selected population. However, the lack of controlled studies, inconsistent reporting of outcomes and heterogeneity of patient selection mean that the quality of evidence is low.
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