Prem Rachna, Vignaraja Vikramman, Lewis Thomas, Budair Basil
Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK.
SAGE Open Med. 2024 Dec 16;12:20503121241306957. doi: 10.1177/20503121241306957. eCollection 2024.
Diabetic Charcot neuro-osteoarthropathy carries a significant worldwide disease burden including diabetic foot infection, ulceration and amputation. The current accepted standard of treatment during the active phase of Charcot neuro-osteoarthropathy is offloading with total contact casting; however, controversy remains regarding weight-bearing status during this period.
A systematic review was performed following PRISMA guidelines of Pubmed, EMBASE, MEDLINE and the Cochrane central register of controlled trials for clinical studies from inception until June 2024 investigating weight-bearing and non-weight-bearing total contact casting for active Charcot neuro-osteoarthropathy.
Four hundred ninety-three studies were identified in the search strategy of which 5 studies met the inclusion criteria comprising 158 patients. These studies found that allowing patients to weight-bear during total contact casting does not have a negative impact on the healing process. There were no comparative studies between weight-bearing and non-weight-bearing total contact casting.
There is limited evidence to support current practice of non-weight bearing in a total contact casting for active Charcot neuro-osteoarthropathy. Allowing patients to weight bear carries advantages to patient independence and quality of life. Further investigation with randomised control trial should be considered to investigate if weight bearing is associated with negative outcomes.
糖尿病夏科氏神经骨关节病在全球范围内造成了重大疾病负担，包括糖尿病足感染、溃疡和截肢。目前公认的夏科氏神经骨关节病活动期治疗标准是采用全接触石膏进行减压；然而，在此期间的负重状态仍存在争议。
按照PRISMA指南，对PubMed、EMBASE、MEDLINE以及Cochrane对照试验中心注册库进行系统综述，纳入自研究起始至2024年6月期间调查活动期夏科氏神经骨关节病负重和非负重全接触石膏治疗的临床研究。
在检索策略中识别出493项研究，其中5项研究符合纳入标准，共纳入158例患者。这些研究发现，在全接触石膏治疗期间允许患者负重对愈合过程没有负面影响。负重和非负重全接触石膏治疗之间没有比较研究。
支持目前对活动期夏科氏神经骨关节病采用非负重全接触石膏治疗的证据有限。允许患者负重对患者的独立性和生活质量有好处。应考虑通过随机对照试验进行进一步研究，以调查负重是否与不良结局相关。
