Anthony Michael L, Cravey Kimberly S, Atway Said A
Assistant Professor, Podiatric Medicine and Surgery Residency Program, The Ohio State University Wexner Medical Center, Columbus, OH.
Resident, Podiatric Medicine and Surgery Residency Program, The Ohio State University Wexner Medical Center, Columbus, OH.
J Foot Ankle Surg. 2019 May;58(3):475-479. doi: 10.1053/j.jfas.2018.09.022. Epub 2019 Feb 11.
Only a small percentage of the general diabetic population develops Charcot neuroarthropathy. Charcot arthropathy greatly increases the risk of foot complications. At our academic institution, there appeared to be an increased incidence of Charcot arthropathy in transplant patients. We hypothesized that Charcot neuroarthropathy incidence is higher in the diabetic patients who had received kidney or kidney-pancreas transplants. The charts of 1000 patients were reviewed from January 2000 to January 2011. Four hundred and eighty-seven patients were included in the study. Of these diabetic patients, 249 had received a kidney transplant and 238 a kidney-pancreas transplant. The data were analyzed for the incidence of Charcot in each group. Other risk factors and sequelae were also evaluated and analyzed. The incidence of Charcot development in the diabetic patients who had a kidney-pancreas transplant was 18.4%, 44 of 238 patients. This was significantly higher than the incidence in kidney transplant patients, which was 11.2%, 28 of 249 patients (p < .05). Peripheral arterial disease was a statistically significant independent risk factor for developing ulceration, osteomyelitis, and subsequent amputation. Type 1 diabetic patients developed Charcot at a higher rate that was also statistically significant compared with type 2 diabetic patients. In our study, diabetic patients who had undergone kidney-pancreas transplants were associated with higher risk for development of Charcot neuroarthropathy than kidney transplants alone. The incidence of Charcot development in both these transplant groups was also much higher than in the general diabetic population. This is of particular interest to clinicians and surgeons as both transplant groups were found to be high risk for subsequent foot ulceration, infection, and amputation.
在普通糖尿病患者中，只有一小部分会发生夏科氏关节病。夏科氏关节病会大大增加足部并发症的风险。在我们的学术机构中，移植患者中夏科氏关节病的发病率似乎有所增加。我们推测，接受肾脏或肾胰联合移植的糖尿病患者中，夏科氏关节病的发病率更高。回顾了2000年1月至2011年1月期间1000例患者的病历。487例患者纳入研究。在这些糖尿病患者中，249例接受了肾脏移植，238例接受了肾胰联合移植。分析了每组中夏科氏关节病的发病率。还对其他危险因素和后遗症进行了评估和分析。接受肾胰联合移植的糖尿病患者中夏科氏关节病的发病率为18.4%（238例患者中有44例）。这显著高于肾脏移植患者的发病率，肾脏移植患者的发病率为11.2%（249例患者中有28例）（p<0.05）。外周动脉疾病是发生溃疡、骨髓炎及随后截肢的统计学显著独立危险因素。1型糖尿病患者发生夏科氏关节病的几率更高，与2型糖尿病患者相比也具有统计学显著性。在我们的研究中，接受肾胰联合移植的糖尿病患者发生夏科氏关节病的风险高于单纯肾脏移植患者。这两个移植组中夏科氏关节病的发病率也远高于普通糖尿病患者群体。这对临床医生和外科医生尤为重要，因为发现这两个移植组随后发生足部溃疡、感染和截肢的风险都很高。
