Podiatric Medicine and Surgery Residency, Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA.
Podiatric Medicine and Surgery Residency, Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Foot Ankle Surg. 2024 Jan-Feb;63(1):114-118. doi: 10.1053/j.jfas.2023.09.008. Epub 2023 Sep 17.
Charcot neuroarthropathy's (CN) anatomic classification was originally formulated by the Brodsky article and the Trepman et al modification, including midfoot (type 1), rearfoot (type 2), ankle (type 3a), calcaneus (type 3b), multiarticular (type 4), and forefoot (type 5). In these classic studies, ankle joint and multijoint CN are reported as 9% and 6% to 9%, respectively, but we believe ankle CN to be more common than that in a tertiary setting. We retrospectively reviewed patients presenting initially or as referral between 2004 and 2020. Initial presentation radiographs were reviewed and classified by 3 authors based on Brodsky's model with Trepman and colleagues' modification, and any discrepancies were reviewed by the fourth author. A total of 175 patients (205 feet) were assessed. This revealed 80 cases classified as type 1 (39.0%), 23 cases type 2 (11.2%), 17 cases type 3a (8.3%), 2 cases type 3b (1.0%), and 83 cases type 4 (40.5%). After subdividing type 4, total prevalence included 150 with type 1 anatomic location (73.2%), 103 type 2 (50.2%), 44 type 3a (21.5%), and still 2 type 3b (1.0%). This study revealed a similar prevalence of isolated ankle CN (8.5%) compared to the Trepman et al article (9%), however, in total, ankle CN (21.5%) occurred 2.4-times more than the original 9%. Our study also found there to be a higher prevalence of ankle CN in the setting of multiarticular CN, which has not been evaluated in past studies. The prevalence of multiarticular CN was found to be 4.5-fold greater than the Trepman article (6%-9%).
夏科氏关节病（CN）的解剖分类最初由 Brodsky 文章和 Trepman 等人的修改版提出，包括中足（1 型）、后足（2 型）、踝关节（3a 型）、跟骨（3b 型）、多关节（4 型）和前足（5 型）。在这些经典研究中，踝关节和多关节 CN 的报告分别为 9%和 6%至 9%，但我们认为在三级医疗机构中，踝关节 CN 更为常见。我们回顾性分析了 2004 年至 2020 年间初次就诊或转诊的患者。由 3 位作者根据 Brodsky 模型和 Trepman 等人的改良版进行初始表现的 X 线片回顾和分类，如果存在任何差异，将由第 4 位作者进行审查。共评估了 175 例患者（205 足）。结果显示，80 例分类为 1 型（39.0%）、23 例为 2 型（11.2%）、17 例为 3a 型（8.3%）、2 例为 3b 型（1.0%）、83 例为 4 型（40.5%）。在对 4 型进行细分后，总患病率包括 150 例解剖部位为 1 型（73.2%）、103 例为 2 型（50.2%）、44 例为 3a 型（21.5%）和 2 例 3b 型（1.0%）。本研究显示，孤立性踝关节 CN（8.5%）的患病率与 Trepman 等人的文章（9%）相似，但总的来说，踝关节 CN（21.5%）的发生频率比最初的 9%高 2.4 倍。我们的研究还发现，在多关节 CN 的情况下，踝关节 CN 的患病率更高，而过去的研究并没有对此进行评估。多关节 CN 的患病率是 Trepman 文章（6%-9%）的 4.5 倍。
