神经病变足损伤所致固定诱导性骨溶解及恢复

Immobilization-induced osteolysis and recovery in neuropathic foot impairments.

机构信息

Program in Physical Therapy, Campus Box 8502, Applied Kinesiology Laboratory, Washington University School of Medicine, Saint Louis, MO, United States.

Dept of Psychology, Campus Box 1125, Washington University, Saint Louis, MO, United States.

出版信息

Bone. 2017 Dec;105:237-244. doi: 10.1016/j.bone.2017.09.009. Epub 2017 Sep 20.

DOI:10.1016/j.bone.2017.09.009

PMID:28942120

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5650927/

Abstract

BACKGROUND

Neuropathic foot impairments treated with immobilization and off-loading result in osteolysis. In order to prescribe and optimize rehabilitation programs after immobilization we need to understand the magnitude of pedal osteolysis after immobilization and the time course for recovery.

OBJECTIVE

To determine differences in a) foot skin temperature; b) calcaneal bone mineral density (BMD) after immobilization; c) calcaneal BMD after 33-53weeks of recovery; and d) percent of feet classified as osteopenic or osteoporotic after recovery in participants with neuropathic plantar ulcers (NPU) compared to Charcot neuroarthropathy (CNA).

METHODS

Fifty-five participants with peripheral neuropathy were studied. Twenty-eight participants had NPU and 27 participants had CNA. Bilateral foot skin temperature was assessed before immobilization and bilateral calcaneal BMD was assessed before immobilization, after immobilization and after recovery using quantitative ultrasonometry.

RESULTS

Before immobilization, skin temperature differences in CNA between their index and contralateral foot were markedly higher than NPU feet (3.0 degree C versus 0.7 degree C, respectively, p<0.01); BMD in NPU immobilized feet averaged 486±136mg/cm, and CNA immobilized feet averaged 456±138mg/cm, p>0.05). After immobilization, index NPU feet lost 27mg/cm; CNA feet lost 47mg/cm of BMD, p<0.05. After recovery, 61% of NPU index feet and 84% of CNA index feet were classified as osteopenic or osteoporotic.

CONCLUSIONS

There was a greater osteolysis after immobilization with an attenuated recovery in CNA feet compared to NPU feet. The attenuated recovery of pedal BMD in CNA feet resulted in a greater percentage of feet classified as osteoporotic and osteopenic.

摘要

背景

采用固定和减压治疗神经病变性足部损伤会导致骨溶解。为了在固定后制定和优化康复方案，我们需要了解固定后足部骨溶解的程度和恢复的时间过程。

目的

确定以下方面的差异：a）足部皮肤温度；b）固定后跟骨骨矿物质密度（BMD）；c）恢复 33-53 周后跟骨 BMD；d）恢复后患有神经病变性足底溃疡（NPU）的参与者与患有 Charcot 神经关节病（CNA）的参与者中，被归类为骨质疏松或骨量减少的足部比例。

方法

研究了 55 名患有周围神经病变的参与者。28 名参与者患有 NPU，27 名参与者患有 CNA。在固定前评估双侧足部皮肤温度，在固定前、固定后和恢复后使用定量超声评估双侧跟骨 BMD。

结果

在固定前，CNA 患者的病变侧与对侧足部之间的皮肤温度差异明显高于 NPU 足部（分别为 3.0°C 和 0.7°C，p<0.01）；NPU 固定足部的 BMD 平均为 486±136mg/cm，CNA 固定足部的 BMD 平均为 456±138mg/cm，p>0.05）。固定后，NPU 病变侧足部丧失 27mg/cm；CNA 病变侧足部丧失 47mg/cm 的 BMD，p<0.05。恢复后，61%的 NPU 病变侧足部和 84%的 CNA 病变侧足部被归类为骨质疏松或骨量减少。