Foot Ulcer Trials Unit, Department of Diabetes and Endocrinology, Nottingham University Hospitals Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
Diabetologia. 2012 Jan;55(1):32-5. doi: 10.1007/s00125-011-2354-7. Epub 2011 Nov 8.
AIMS/HYPOTHESIS: We studied factors associated with the development and resolution of acute Charcot foot using a web-based observational study.
Clinicians managing cases of acute Charcot foot in the UK and Ireland between June 2005 and February 2007 were invited to register anonymised details on a secure website.
A total of 288 cases (age 57.0 ± 11.3 years [mean ± SD]; 71.2% male) were registered from 76 centres. Of these, 36% of patients recalled an episode of relevant trauma in the preceding 6 months, while 12% had had surgery to the affected foot. In 101 (35%) cases, ulceration was present at registration and 20% of these had osteomyelitis. Non-removable off-loading devices were used at presentation in 35.4% of cases, with removable off-loading used in 50%. Data on resolution were available for 219 patients. The median time to resolution was 9 months in patients whose initial management included the use of non-removable off-loading, compared with 12 months in the remainder (p = 0.001). Bisphosphonates were administered intravenously in 25.4% and orally in 19.4% of cases. The median time to resolution in patients who received bisphosphonates was 12 months and was longer than in those who did not (10 months, p = 0.005).
CONCLUSIONS/INTERPRETATION: The median time to resolution was longer than in earlier series. Although limited by being observational and non-randomised, these data suggest that the use of non-removable off-loading at presentation may shorten the time to resolution. They provide no evidence to indicate that the use of bisphosphonates is beneficial.
目的/假设：我们通过一个基于网络的观察性研究，研究了与急性夏科足的发生和缓解相关的因素。
2005 年 6 月至 2007 年 2 月期间，英国和爱尔兰的临床医生被邀请在一个安全的网站上注册匿名的详细信息。
共登记了 288 例病例（年龄 57.0±11.3 岁[均值±标准差]；71.2%为男性），来自 76 个中心。其中，36%的患者在过去 6 个月内有相关创伤的发作，而 12%的患者曾对受影响的脚进行过手术。在 101 例（35%）病例中，在登记时存在溃疡，其中 20%有骨髓炎。在初始治疗中使用不可移动的减压装置的病例中，35.4%有溃疡，50%使用可移动减压装置。219 例患者有缓解的数据。在初始治疗中使用不可移动减压装置的患者的缓解中位数时间为 9 个月，而其余患者为 12 个月（p=0.001）。25.4%的患者静脉内给予双膦酸盐，19.4%的患者口服给予双膦酸盐。接受双膦酸盐治疗的患者的缓解中位数时间为 12 个月，长于未接受治疗的患者（10 个月，p=0.005）。
结论/解释：缓解的中位数时间长于早期系列。尽管受到观察性和非随机性的限制，但这些数据表明，在就诊时使用不可移动的减压装置可能会缩短缓解时间。它们没有提供证据表明使用双膦酸盐是有益的。
