糖尿病夏柯氏神經骨關節病變(Charcot's Neuro-Osteoarthropathy)的成因、預防及治療

Pathoetiology, Prevention, and Treatment of Charcot's Neuro-osteoarthropathy in Diabetic Patients

李奕辰(Yi-Chen Li) ； 高玉禧(Yu-Hsi Kao) ； 陳沛裕(Pei-Yu Chen) ； 楊榮森(Rong-Sen Yang)

《台灣老年醫學暨老年學雜誌》 5卷4期 (2010/11) Pp. 235-247

https://doi.org/10.29461/TGG.201011.0001

摘要

夏柯氏神經骨關節病變是糖尿病病人常見的併發症之一，通常發生在50到60歲之間的中年人，同時比例隨著罹患糖尿病時間和神經病變嚴重度增加而上升。本病好發在足部的位置，由於臨床上的表現和蜂窩性組織炎及骨髓炎類似，加上大多數臨床醫師並不熟悉，常常被當成感染來治療而錯失早期介入的契機。夏柯氏神經骨關節病變的致病機轉目前仍不明朗，周邊神經病變、反覆性的創傷發炎激素和神經傳導因子失衡被認為是主要的成因。診斷上除了臨床表現以外，從影像學也可以提供診斷上的幫忙，不過臨床醫師的警覺心仍然是最重要的。早期病變可以採用保守或藥物的治療方式。手術的角色主要針對保守治療失敗的末期病患，減除病人的不適或控制感染的症狀。近來許多研究也指出，應該建議病人早期接受復健療程以改善病情。
隨著老年人口的增加及現代人生活習慣的改變，糖尿病足及夏柯氏神經骨關節病變也成為許多內分泌科及骨科醫師棘手的問題。由於病人初期大多不會有嚴重或特異的症狀，以致於病患本身及臨床醫師時常忽略其警訊，未予以適切的治療和保護，導致疾病快速的進展，最後導致骨關節的破壞變形及功能喪失。希望藉由文獻的回顧，增加對疾病的了解，可以提高第一線臨床醫師的警覺性，讓更多的病患在早期可以接受適切的治療，以減少嚴重併發症及足部功能喪失。

關鍵字

糖尿病足 ； 夏柯氏神經骨關節病變 ； 發炎因子

並列摘要

Charcot's neuro-osteoarthropathy (CNO) is one of the most notorious complications of diabetes. With clinical presentations similar to those of cellulitis or osteomyelitis, it is often diagnosed as infection, causing the patient to miss the golden time for early treatment. While the pathoetiology of CNO remains under debate, peripheral neuropathy, repeated trauma, and dysregulation of inflammatory cytokines are generally considered to be leading causes.
Clinical presentation and image studies are obscure clues for physicians to make the diagnosis. Therefore, most important of all, physicians should always be alert to it. In the early stage, patient should receive conservative treatments or medications and leave surgical intervention to terminal cases with failed conservative treatment in order to control intractable pain or infection. Early intervention by vigorous rehabilitation programs has already shown some benefits in recent studies.
With the rapid aging population and changing life style in the modern era, diabetes (DM) foot and CNO have become knotty problems to endocrinologist and orthopaedic surgeons. This article endeavors to provide more information and solicit greater attention to this ongoing disease to provide more proper treatment of the patients in early stages.

並列關鍵字

diabetic foot ； Charcot's neuro-osteoarthropathy ； inflammatory cytokines