Myerson M S, Henderson M R, Saxby T, Short K W
Union Memorial Hospital, Foot and Ankle Services, Baltimore, Maryland.
Foot Ankle Int. 1994 May;15(5):233-41. doi: 10.1177/107110079401500502.
Between 1986 and 1990, we treated 68 patients with diabetes and neuroarthropathy of the midfoot, 21 of whom had bilateral involvement. Patients were managed according to a strict protocol defined by activity of the neuroarthropathy, instability, ulceration, infection, and ischemia. Initial management of acute neuroarthropathy (18 feet) was open reduction and arthrodesis (8), a total-contact cast or brace (9), and amputation (1). All patients with subacute neuroarthropathy (30 feet) were initially treated in a total contact cast. Four of these feet subsequently required amputation, two required arthrodesis, and one required exostectomy. For chronic neuroarthropathy (41 feet), a total-contact cast or a molded orthotic insert with or without bracing was used initially in all feet. Subsequent surgical salvage for this group included arthrodesis (9), plantar exostectomy (6), amputation (2), and abscess drainage (2). Four patients died during this treatment period and 64 patients (85 feet) were evaluated at a mean interval of 3 years (range 1-6 years) after initiation of treatment. This treatment program was found to be successful in 82 of 85 feet treated.
1986年至1990年间，我们治疗了68例患有糖尿病和中足神经关节病的患者，其中21例为双侧受累。患者根据由神经关节病的活动度、不稳定、溃疡、感染和缺血所定义的严格方案进行管理。急性神经关节病（18只足）的初始治疗为切开复位和关节融合术（8例）、全接触石膏或支具（9例）以及截肢（1例）。所有亚急性神经关节病（30只足）患者最初均采用全接触石膏治疗。其中4只足随后需要截肢，2只足需要关节融合术，1只足需要骨赘切除术。对于慢性神经关节病（41只足），所有足最初均使用全接触石膏或带有或不带有支具的定制矫形鞋垫。该组随后的手术挽救措施包括关节融合术（9例）、足底骨赘切除术（6例）、截肢（2例）和脓肿引流（2例）。在此治疗期间有4例患者死亡，64例患者（85只足）在开始治疗后平均3年（范围1 - 6年）接受了评估。在接受治疗的85只足中，发现该治疗方案在82只足上取得了成功。
