Program in Physical Therapy, Washington University School of Medicine in St. Louis, Campus Box 8502, 4444 Forest Park Blvd., Room 1101, St. Louis, MO 63108, United States.
Mallinckrodt Institute of Radiology, Division of Radiological Science, Washington University School of Medicine in St. Louis, 510 South Kingshighway Blvd., St. Louis, MO 63110, United States.
Foot (Edinb). 2021 Jun;47:101777. doi: 10.1016/j.foot.2021.101777. Epub 2021 May 3.
Diabetes mellitus (DM) with peripheral neuropathy (PN) results in foot deformity increasing ulceration, joint dislocation, and amputation risk. This study describes the frequency and severity of foot and ankle musculoskeletal abnormalities and their relationship to radiographic alignment in people with DMPN with (DMPN + MCD) and without (DMPN - MCD) medial column deformity (MCD) compared to age- and body mass index-matched controls without DMPN or MDC.
DMPN + MCD (n = 11), DMPN - MCD (n = 12), and controls (n = 12) were studied. A radiologist scored foot and ankle magnetic resonance images (MRI) for abnormalities in tendons/fascia, ligaments, muscles, joints, and bones. Higher scores represent greater abnormalities. Foot alignment was measured from lateral weightbearing radiographs. Frequency of abnormalities between groups and relationships between abnormalities and foot alignment in the combined group (n = 35) were examined.
DMPN + MCD had higher total muscle, joint, and bone scores compared to controls and higher total joint scores than DMPN - MCD. DMPN - MCD had higher total muscle scores than controls. DMPN + MCD higher bone and joint scores were driven by increased frequency of osteophytes, cartilage damage, focal bone marrow edema, new bone formation, and subchondral cysts. Significant correlations included cuboid height and total bone and joint scores (ρ = -0.37 and ρ = -0.40, respectively) and talar declination angle and total joint score (ρ = 0.38).
High contrast resolution MRI allowed identification of structural lesions of the foot affecting the cartilage surfaces, bone marrow, and soft tissue supports in patients with DMPN + MCD. As expected, the presence of bone and joint lesions on MRI were strongly associated with DMPN + MCD; surprisingly, although the sample is small, lesions of the soft tissue supports were not associated with MCD. While MRI is not done routinely to investigate MCD, opportunistic use of the information from MRI done for the common clinical indications may allow early identification of the structural lesions associated with MCD and facilitate early, aggressive therapy.
III.
患有周围神经病变（PN）的糖尿病（DM）会导致足部畸形增加，溃疡、关节脱位和截肢的风险也会增加。本研究描述了伴有（DMPN+MCD）和不伴有（DMPN-MCD）内侧柱畸形（MCD）的糖尿病周围神经病变患者（DMPN+MCD）与年龄和体重指数匹配的无糖尿病或 MCD 对照组相比，足部和踝关节肌肉骨骼异常的频率和严重程度及其与放射影像学对线的关系。
研究了 DMPN+MCD（n=11）、DMPN-MCD（n=12）和对照组（n=12）。一位放射科医生对足部和踝关节磁共振成像（MRI）的肌腱/筋膜、韧带、肌肉、关节和骨骼异常进行评分。较高的分数表示更严重的异常。从侧位负重 X 线片上测量足部对线。检查了各组之间异常的发生频率以及在联合组（n=35）中异常与足部对线之间的关系。
与对照组相比，DMPN+MCD 的肌肉、关节和骨骼总评分较高，与 DMPN-MCD 相比，DMPN+MCD 的关节总评分较高。DMPN-MCD 的肌肉总评分高于对照组。DMPN+MCD 的骨和关节评分较高，是由于骨赘、软骨损伤、局灶性骨髓水肿、新骨形成和软骨下囊肿的发生率增加所致。显著相关性包括骰骨高度和总骨与关节评分（ρ=-0.37 和 ρ=-0.40）以及距骨倾斜角和总关节评分（ρ=0.38）。
高对比度分辨率 MRI 可识别影响软骨表面、骨髓和软组织支撑物的足部结构病变，这些病变存在于 DMPN+MCD 患者中。正如预期的那样，MRI 上骨和关节病变的存在与 DMPN+MCD 密切相关；令人惊讶的是，尽管样本较小，但软组织支撑物的病变与 MCD 无关。虽然 MRI 不是常规用于调查 MCD，但在常见临床指征下进行 MRI 时，可利用 MRI 提供的信息尽早识别与 MCD 相关的结构病变，并促进早期积极治疗。
III。
