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类风湿关节炎中红色无创伤性肿胀足部夏科关节病不寻常鉴别诊断的病例报告

Case Report of an Unusual Differential Diagnosis of a Red and Atraumatic Swollen Foot Charcot Arthropathy in Rheumatoid Arthritis.

作者信息

Berger-Groch J, Falkenberg C S, Schöntag S, Reize P

机构信息

Clinic of Trauma and Orthopaedic Surgery, Klinikum Stuttgart, Stuttgart, Germany.

Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

J Orthop Case Rep. 2022 Nov;12(11):100-104. doi: 10.13107/jocr.2022.v12.i11.2432.

Abstract

INTRODUCTION

Neuropathic osteoarthropathy of the foot and ankle (Charcot foot) is a disease that can lead to progressive malpositioning and deformation up to complete collapse of the foot. In most cases, diabetic polyneuropathy is the underlying disease, but polyneuropathy of any cause can lead to neuropathic osteoarthropathy. Pathogenesis is still not completely understood. Due to the non-specific clinical presentation, the symptoms of Charcot arthropathy are generally easily misdiagnosed and proper therapy is delayed, especially in patients with an underlying disease other than diabetes mellitus. To date, published literature on patients with rheumatoid arthritis who develop neuropathic osteoarthropathy of the foot is scarce.

CASE REPORT

We present a rare case of a 61-year-old patient with Charcot foot and rheumatoid arthritis. The patient presented with an extreme foot deformity after a failed conservative treatment. The surgical procedures, complications, and outcome are described. The pitfalls in this special patient group are highlighted.

CONCLUSION

If necessary, a variety of surgical options are available to maintain ambulation and prevent infection from open ulcers and amputation. For surgical management of patients with rheumatoid arthritis, the overall statics of the lower extremity and the influence of antirheumatic drugs must be considered.

摘要

引言

足踝部神经性骨关节病(夏科氏足)是一种可导致足部逐渐出现位置异常和变形,直至完全塌陷的疾病。在大多数情况下,糖尿病性多发性神经病是其潜在病因,但任何原因引起的多发性神经病都可导致神经性骨关节病。其发病机制仍未完全明确。由于临床表现不具有特异性,夏科氏关节病的症状通常很容易被误诊,恰当的治疗也会被延误,尤其是在患有糖尿病以外其他基础疾病的患者中。迄今为止,关于类风湿关节炎患者发生足部神经性骨关节病的已发表文献很少。

病例报告

我们报告一例61岁患有夏科氏足和类风湿关节炎的罕见病例。该患者在保守治疗失败后出现了严重的足部畸形。描述了手术过程、并发症及结果。强调了这一特殊患者群体中存在的问题。

结论

如有必要,可采用多种手术方案来维持行走能力,并预防开放性溃疡感染和截肢。对于类风湿关节炎患者的手术治疗,必须考虑下肢的整体力学情况以及抗风湿药物的影响。

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