Jones Christopher W, Agolley David, Burns Kharis, Gupta Sanjeev, Horsley Mark
Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Foot (Edinb). 2012 Sep;22(3):258-63. doi: 10.1016/j.foot.2012.06.001. Epub 2012 Jul 24.
The clinical presentation of acute Charcot arthropathy in the diabetic population usually follows the Eichenholtz classification. We present three usual cases of Charcot arthropathy presenting with rapid primary bone resorption in the absence of subluxation, dislocation and/or fracture.
A review of the literature was performed. To our knowledge Charcot arthropathy has not been previously described as primary bone resorption.
Three cases encountered at our specialist multidisciplinary High Risk Foot Clinic (HRFC) presented with primary bony resorption without features of subluxation, dislocation and/or fracture.
Aggressive primary bone resorption was initially thought due to infection; a diagnostic dilemma that delayed optimal treatment. Late bone resorption in typical Charcot is linked to unregulated proinflammatory cytokines (IL-1β, IL-6 and TNFα) that lead to increased osteoclastic activity. The pathophysiology of osteolysis in aggressive primary bony resorption may relate to a disturbance in the balance between RANK-L and OPG.
Primary resorption of bone without subluxation, dislocation and/or fracture can represent an active Charcot process. Prudent use of serial radiography and early MRI to look for the widespread bone and soft tissue oedema is recommended.
糖尿病患者急性夏科氏关节病的临床表现通常遵循艾兴霍尔茨分类法。我们报告三例典型的夏科氏关节病病例，其表现为快速的原发性骨质吸收，且无半脱位、脱位和/或骨折。
进行文献回顾。据我们所知，此前尚未将夏科氏关节病描述为原发性骨质吸收。
在我们的专科多学科高危足病诊所（HRFC）遇到的三例病例均表现为原发性骨质吸收，无半脱位、脱位和/或骨折特征。
最初认为侵袭性原发性骨质吸收是由感染引起的，这一诊断难题延误了最佳治疗。典型夏科氏关节病的晚期骨质吸收与不受调控的促炎细胞因子（白细胞介素-1β、白细胞介素-6和肿瘤坏死因子α）有关，这些细胞因子会导致破骨细胞活性增加。侵袭性原发性骨质吸收中骨溶解的病理生理学可能与核因子κB受体活化因子配体（RANK-L）和骨保护素（OPG）之间的平衡紊乱有关。
无半脱位、脱位和/或骨折的原发性骨质吸收可能代表活跃的夏科氏病过程。建议谨慎使用系列X线摄影和早期磁共振成像来寻找广泛的骨和软组织水肿。
