Spontaneous Calcaneal Fracture of Charcot Neuroarthropathy in Diabetic Patients-Three Case Reports and Literature Review

糖尿病患者跟骨自發性骨折夏克式神經骨關節病變－三病例報告及文獻回顧

楊學穎(Hsueh-Ying Yang) ； 楊振(Cheng Yang) ； 黃國峯(Kuo-Feng Huang) ； 林聿山(Yu-San Lin)

《中華民國整形外科醫學會雜誌》 18卷4期 (2009/12) Pp. 373-380

https://doi.org/10.7096/JPSA.200912.0373

摘要

背景：
夏克式神經骨關節病變是糖尿病患者下肢周邊神經併發症之一，它是一種漸進式足部及腳踝骨關節的破壞，進而造成骨折或脫臼，甚至需要進行截肢來控制感染或提供肢體穩定度。其發生率甚低，且常難以被診斷出來。
目標與方法：
本院自2003年二月至2008年二月間以病例回顧之方式搜尋出三例糖尿病病患併發自發性跟骨骨折病例。
結果：
此三病例於Brodsky's分類中屬最為罕見之類別。隨著病變的程度及伴隨的症狀其治療方式亦有所不同。在此三病例的治療方式，兩例是接受開放復位固定手術，一例是行膝下截肢手術。
結論：
由於夏克式神經骨關節病變是一種漸進式的病變。糖尿病患者併發此種併發症若能及早謹慎治療，如早期固定或非負重治療，手術復位或截肢情況便可避免。

並列摘要

Background:
Charcot neuroarthropathy is one of the low extremity complications in diabetes mellitus peripheral neuropathy. It is a progressive destruction of foot and ankle joint, which may cause bony fracture or dislocation. In its late stage, amputation may be needed to control infection or provide limbs stability. The prevalence of Charcot neuroarthropathy is low, and its diagnosis needs high index of suspicion.
Aim and Objectives:
To report three cases of spontaneous calcaneal fracture of Charcot neuroarthropathy in our institution and review previous articles.
Materials and Methods:
From 2003 February to 2008 February, three diabetic patients with spontaneous calcaneal farcture of Charcot neuroarthropathy were collected in a retrospective chart review.
Results:
All cases were the least common type in Brodsky’s classification (Type IIIB). The treatment of each case is variable according to the degree of fracture displacement and associated symptoms. Two cases underwent open reduction and internal fixation while one received below knee amputation.
Conclusion:
Charcot neuroarthropathy is a progressive destructive process. If diabetic patients with this complication are treated cautiously from the beginning, such as nonweightbearing and early immobilization, surgical reduction or limbs amputation can be avoided.

並列關鍵字

Charcot neuroarthropathy ； diabetes mellitus ； calcaneal fracture