Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Department of Endocrinology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Nagoya J Med Sci. 2023 Feb;85(1):185-194. doi: 10.18999/nagjms.85.1.185.
Charcot neuroarthropathy (CN) is a serious diabetic complication with a poor prognosis and a high rate of misdiagnosis. Furthermore, beta(2)-microglobulin amyloidosis (Abeta2M) makes the diagnosis and therapy more difficult and complex. This case report highlights the pathophysiology, clinical evaluation, treatment, and prevention of the major diabetic complications associated with CN and Abeta2M that cause poor quality of life, limit the patient's ability to walk independently, and are directly or indirectly linked with a high risk for lower limb amputation. Ankle CN was discovered in a 36-year-old single female with a history of type 1 diabetes mellitus and diabetic nephropathy. We performed early internal fixation. However, because she lived alone and needed hemodialysis three times a week, wearing a brace and non-weight-bearing were extremely inconvenient. Furthermore, she did not experience any pain and only some edema; thus, she proceeded to bear weight ahead of schedule without authorization. Due to the premature weight-bearing and poor compliance, the patient suffered severe bone resorption and infection and eventually had to undergo amputation. Abeta2M was suggested by bone pathological sections. We present a case of failed internal fixation of ankle CN with Abeta2M, emphasizing the importance of social factors and postoperative management.
夏科氏关节病（CN）是一种严重的糖尿病并发症，预后不良，误诊率高。此外，β2-微球蛋白淀粉样变性（Abeta2M）使诊断和治疗更加困难和复杂。本病例报告强调了与 CN 和 Abeta2M 相关的主要糖尿病并发症的病理生理学、临床评估、治疗和预防，这些并发症导致生活质量下降，限制了患者独立行走的能力，并直接或间接导致下肢截肢的风险增加。一名 36 岁的单身女性患有 1 型糖尿病和糖尿病肾病，患有踝关节 CN。我们进行了早期内固定。然而，由于她独居且每周需要进行三次血液透析，佩戴支具和不负重非常不方便。此外，她没有感到任何疼痛，只有一些肿胀；因此，她未经授权提前开始负重。由于过早负重和不遵医嘱，患者遭受严重的骨质吸收和感染，最终不得不进行截肢。骨骼病理切片提示 Abeta2M。我们报告了一例踝关节 CN 内固定失败伴 Abeta2M 的病例，强调了社会因素和术后管理的重要性。
