在棘手的地面上行走:重建方法的沙科神经性关节病的脚

D. Ion
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引用次数: 0

摘要

简介和目的:Charcot神经关节病定义了糖尿病患者的一系列进行性病变,影响关节和骨骼以及足部软组织,周围神经病变在其中起着关键作用。感觉和本体感觉的丧失、随后的反复创伤、肌肉和自主神经系统损伤会导致足部结构和压力分布的改变,最终引发溃疡和坏疽。避免截肢的迫切愿望推动了保守和重建技术的发展,这些技术即使不能防止这种负面结果,也能推迟。本综述的目的是介绍最常用的重建手术,以及使其适应特定足部形态和病变阶段所带来的挑战。方法:通过PubMed进行文献检索,共获得90篇左右的文献、多中心研究和综述,其中26篇被认为对糖尿病神经病变优于动脉病变的Charcot足患者的骨科重建和术后护理提供了最相关的指导。结果:跗跖关节和跖趾关节最常受影响。闭合复位、关节融合术和肌腱延长是有效矫正的关键特征,同时伴有切除和肌腱切断术。溃疡和老茧清创也是必要的,而长时间的铸造和固定仍然是强制性的。结论:大多数作者认为稳定畸形、优化软组织压力、促进潜在病变愈合是干预的主要目的。及时识别和矫正夏科足畸形可提高生活质量,减少截肢的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot
Abstract Introduction and purpose:Charcot neuroarthropathy defines a cluster of progressive lesions affecting the joints and bones, as well as the soft tissues of the foot in the context of diabetes, a pivotal role being attributed to peripheral neuropathy. Loss of sensation and proprioception, subsequent repeated trauma, muscle and autonomic nervous system impairment contribute to the alteration of the foot’s architecture and distribution of pressure, ultimately triggering ulceration and gangrene. The urge to avoid amputation has fueled the development of conservative and reconstructive techniques capable of delaying, if not preventing such negative outcomes. The purpose of this review was to present the most frequently used reconstruction procedures and the challenges arising in adapting them to particular foot morphologies and lesion stages. Methods:Literature search was conducted using PubMed, resulting in around 90 articles, multicenter studies and reviews, 26 of which were considered most relevant in providing the guidelines for orthopedic reconstruction and postoperative care in Charcot foot patients with diabetic neuropathy prevailing over arteriopathy. Results:The tarsometatarsal and metatarsophalangeal joints are most frequently affected. Closed reduction, arthrodesis, and tendon lengthening are key features of an efficient correction, alternatively accompanied by resections and tenotomies. Ulceration and callus debridement may also be necessary, while prolonged casting and immobilization remain obligatory. Conclusions:Most authors agree that stabilizing the deformities, optimizing the pressure on the soft tissues, and promoting the healing of potential lesions are the main purposes of the interventions. Prompt recognition and correction of Charcot foot deformities improve life quality and minimize the prospects of amputation.
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