Qidwai S A, Khan M A, Hussain S R, Malik M S
King Khalid Hospital, Najran, Kingdom of Saudi Arabia.
Saudi Med J. 2001 Feb;22(2):142-5.
This study was undertaken to assess the incidence of diabetic neuroarthropathy and its related morbidity.
The medical records of 296 diabetic patients were analyzed retrospectively between June of 1998 and July of 1999. The patients with long standing, poorly controlled diabetes mellitus and associated peripheral neuropathy were evaluated clinically and radiographically for the presence of arthropathic changes in the feet. Clinically, neuropathy was considered if there was absence of ankle jerk or glove and stocking sensory loss, or both. Radiographically, the presence of stress fractures, dislocation/subluxation, lytic or arthritic lesions of the bone and joints were taken as indicative of the disease. They were treated conservatively by total contact casting or surgically in the form of ray excision, amputation and skin grafting. They were followed up for an average period of 13 months. Results were evaluated clinically and radiographically.
The maximum incidence of diabetes mellitus was in the age group of 41-80 years. Diabetic neuropathy was present in 37 patients (12.5%). Male to female ratio was 23:14 with an average age of 70.42 years. The mean duration of diabetes mellitus was 14.2 years. Seventeen feet in 11 patients (4%) were found to have diabetic neuroarthropathy. The joints involved were tarsometatarsal (76%), metatarsophalangeal (59%), subtalar (47%) and interphalangeal joints (41%). Two patients underwent foot amputations. Patients treated with total contact casting resulted in satisfactory progress.
Diabetic neuroarthropathy, a less recognized complication of diabetes mellitus needs greater attention in Saudi Arabia. High-risk feet should be subjected to routine radiographs or preferably a computerized tomography examination. The timely detection of this problem can save many patients from disastrous complications.
本研究旨在评估糖尿病性神经关节病的发病率及其相关发病率。
回顾性分析1998年6月至1999年7月期间296例糖尿病患者的病历。对患有长期、控制不佳的糖尿病及相关周围神经病变的患者进行临床和影像学评估，以确定足部是否存在关节病变。临床上，如果没有踝反射或手套袜套样感觉丧失，或两者皆无，则考虑存在神经病变。影像学上，应力性骨折、脱位/半脱位、骨与关节的溶骨性或关节炎性病变的存在被视为该疾病的指征。他们接受了全接触石膏固定的保守治疗或采用射线切除、截肢和植皮等手术治疗。平均随访13个月。从临床和影像学方面对结果进行评估。
糖尿病发病率最高的年龄组为41 - 80岁。37例患者（12.5%）存在糖尿病神经病变。男女比例为23:14，平均年龄为70.42岁。糖尿病的平均病程为14.2年。11例患者（4%）的17只足部被发现患有糖尿病性神经关节病。受累关节为跗跖关节（76%）跖趾关节（59%）、距下关节（47%）和指间关节（41%）。2例患者接受了足部截肢手术。接受全接触石膏固定治疗的患者取得了满意的进展。
糖尿病性神经关节病是一种较少被认识到的糖尿病并发症，在沙特阿拉伯需要更多关注。高危足部应进行常规X线检查，或最好进行计算机断层扫描检查。及时发现这个问题可以使许多患者避免灾难性并发症。
