踝关节夏科氏神经关节病的管理：一项系统评价
Management of Ankle Charcot Neuroarthropathy: A Systematic Review.
作者信息
Galhoum Ahmed ElSayed, Trivedi Vineet, Askar Mohamed, Tejero Sergio, Herrera-Pérez Mario, AlRashidi Yousef, Valderrabano Victor
机构信息
George Eliot Hospital NHS Trust, Nuneaton CV114LG, UK.
Ashford and St. Peter Hospital, NHS, London TW153AA, UK.
出版信息
J Clin Med. 2021 Dec 17;10(24):5923. doi: 10.3390/jcm10245923.
BACKGROUND
Charcot neuroarthropathy is a non-infective, destructive process occurring in patients rendered insensate by peripheral neuropathy, which is caused mainly by diabetes. Repetitive trauma from standing and walking provides a neuro-traumatic stimulus that leads to dislocation, or peri-articular fracture, or both, within the ankle. This review concentrates on the management protocols regarding the ankle only.
METHODS
A Pubmed search for clinical trials performed to manage ankle Charcot neuroarthropathy and a systematic review of these articles were undertaken.
RESULTS
Twenty papers met the inclusion criteria: four of them describe non-surgical management, while the rest show different surgical management options of ankle Charcot neuroarthropathy.
CONCLUSIONS
Surgical algorithms for the treatment of CN of the ankle are based almost entirely on level four. There is inconclusive evidence concerning the timing of treatment and the use of different fixation methods. Instability and ulceration are the main precursors for surgical interventions. Prospective series and randomized studies, albeit difficult to perform, are necessary to support and strengthen current practice.
背景
夏科氏关节病是一种发生于因周围神经病变（主要由糖尿病引起）而感觉缺失患者的非感染性破坏性病变。站立和行走产生的重复性创伤提供了一种神经创伤刺激，可导致踝关节脱位、关节周围骨折或两者皆有。本综述仅聚焦于踝关节的治疗方案。
方法
在PubMed上检索用于治疗踝关节夏科氏关节病的临床试验，并对这些文章进行系统综述。
结果
20篇论文符合纳入标准：其中4篇描述了非手术治疗，其余论文展示了踝关节夏科氏关节病的不同手术治疗方案。
结论
踝关节夏科氏关节病的手术治疗方案几乎完全基于四级证据。关于治疗时机和不同固定方法的使用，证据尚无定论。不稳定和溃疡是手术干预的主要先兆。前瞻性系列研究和随机研究虽难以开展，但对于支持和强化当前治疗方法是必要的。
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