长期糖尿病患者中的无症状夏科足

摘要(中文译文)

夏科神经性骨关节病在普通门诊糖尿病患者中估计占0.1%~7.5%，但误诊率仍然很高——部分原因是足部常表现为温暖、肿胀和无痛，而非明显的畸形。在已发表的系列研究中，未确诊的病例占0.4%~13%。旨在通过平片X线在长期随访的长期糖尿病患者中、于临床畸形出现之前检测临床前夏科病。这是一项横断面患病率/筛查研究，对2023年9月至2024年3月期间在拉马迪教学医院就诊的60例连续病程超过10年的2型糖尿病（DM）成人患者进行结构化短期随访（仅限于X线阳性患者）。所有患者均接受双足X线正位和斜位检查、完整的临床和神经系统评估，以及包括HbA1c在内的实验室检查。31例患者（51.7%）的X线改变符合预先设定的夏科模式——主要为局灶性骨矿物质脱失、软骨下碎裂及关节边缘碎屑形成。X线阳性与年龄较大（= 0.024）、DM病程较长（< 0.001）、HbA1c较高（< 0.001）和BMI较高（< 0.001）显著相关。性别和药物类型无显著意义。在6个月随访时，31例初始阳性病例中有6例（19.4%）显示影像学进展；所有患者均接受了MRI检查，并采用全接触石膏或气动步行靴进行减负处理。大多数病例的这些发现未与MRI或经过验证的分期系统进行裁定比对，代表的是影像学怀疑而非确诊的神经性关节病。超过半数接受常规随访的长期糖尿病患者具有符合夏科模式的X线改变，尽管大多数未经MRI确认。这些发现支持进一步研究，在更大样本中进行MRI验证性确认，之后才能推荐在该人群中系统开展双足平片X线筛查；与此同时，优化血糖控制和教育患者避免创伤仍然是适当的。

Abstract

Charcot neuropathic osteoarthropathy complicates an estimated 0.1-7.5% of diabetic patients in general clinic populations, yet misdiagnosis rates remain high - partly because the foot is often warm, swollen, and painless rather than obviously deformed. Undiagnosed cases range from 0.4% to 13% in published series. To detect preclinical Charcot disease by plain X-ray in longstanding diabetic patients attending routine follow-up, before clinical deformity develops. Cross-sectional prevalence/screening study, with structured short-term follow-up restricted to X-ray-positive patients, of 60 consecutive adults with type 2 diabetes mellitus (DM) of >10 years duration, seen at Al-Ramadi Teaching Hospitals between September 2023 and March 2024. All underwent bilateral foot X-ray in antero-posterior and oblique views, full clinical and neurological assessment, and laboratory investigations including HbA1c. Thirty-one patients (51.7%) had X-ray changes fulfilling a pre-specified Charcot pattern - predominantly focal bone demineralization, subchondral fragmentation, and debris formation at articular margins. X-ray positivity correlated significantly with older age ( = 0.024), longer DM duration ( < 0.001), higher HbA1c ( < 0.001), and greater BMI ( < 0.001). Gender and medication type were not significant. At 6-month follow-up, six of the 31 initially positive cases (19.4%) showed radiological progression; all underwent MRI and were offloaded with total contact cast or airwalker. These findings were not adjudicated against MRI or a validated staging system in most cases and represent radiographic suspicion rather than confirmed neuroarthropathy. Over half of longstanding diabetic patients attending routine follow-up had X-ray changes fulfilling a Charcot pattern, though most were not MRI-confirmed. These findings support further investigation, with MRI-validated confirmation in a larger sample, before systematic plain bilateral foot X-ray screening can be recommended in this population; glycemic optimization and patient education on trauma avoidance remain appropriate in the meantime.

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