Diabetic Foot Clinic, King's College Hospital, London, UK.
Diabetes Obes Metab. 2013 Mar;15(3):193-7. doi: 10.1111/j.1463-1326.2012.01671.x. Epub 2012 Sep 20.
Charcot arthropathy is a major complication of diabetes and it poses management challenges to health care professionals. Early diagnosis and timely intervention are essential for improved outlook of these patients. Casting therapy has been accepted as the mainstay treatment of the acute Charcot foot, although there are still controversies regarding its duration, the choice of removable and non-removable device and weight-bearing casts vs. non-weight-bearing casts. Two groups of antiresorptive therapies have been evaluated in the treatment of the acute Charcot foot, bisphosphonates (intravenous and oral) and calcitonin. These therapies have clearly shown a reduction of bone turnover, although, they have not shown a significant effect on temperature reduction. Current evidence to support their use is weak. An anabolic agent to speed up clinical resolution and fracture healing may be helpful and a clinical trial to evaluate the possible benefit of 1-84 recombinant human parathyroid hormone on fracture healing in the acute Charcot foot is in progress. This paper summarises the current approach to medical management of acute Charcot arthropathy with specific emphasis on casting and pharmacological therapy. Emerging new studies of the pathogenesis of this condition are also discussed.
夏科氏关节病是糖尿病的一种主要并发症，对医疗保健专业人员提出了管理挑战。早期诊断和及时干预对于改善这些患者的预后至关重要。尽管在急性夏科氏足的持续时间、可移动和不可移动设备的选择、负重石膏与非负重石膏的选择等方面仍存在争议，但石膏固定治疗已被接受为急性夏科氏足的主要治疗方法。有两组抗吸收疗法已被评估用于治疗急性夏科氏足，即双膦酸盐（静脉内和口服）和降钙素。这些治疗方法显然显示出降低骨转换的作用，尽管它们对降低体温没有显著效果。目前支持其使用的证据很薄弱。一种促进临床缓解和骨折愈合的合成代谢药物可能会有所帮助，目前正在进行一项临床试验，以评估 1-84 重组人生长激素对急性夏科氏足骨折愈合的可能益处。本文总结了急性夏科氏关节病的医学治疗方法，特别强调了石膏固定和药物治疗。还讨论了该疾病发病机制的新兴新研究。
