Ya. V. Dvoryanchikov, A. Y. Tokmakova, G. Galstyan, M. S. Sheremeta, A. A. Trukhin
{"title":"利用医学成像技术鉴别诊断糖尿病神经性关节病和骨髓炎","authors":"Ya. V. Dvoryanchikov, A. Y. Tokmakova, G. Galstyan, M. S. Sheremeta, A. A. Trukhin","doi":"10.14341/serg12842","DOIUrl":null,"url":null,"abstract":"According to modern concepts, Charcot’s neuro-osteoarthropathy (Charcot’s foot) is considered as an aseptic inflammatory process in individuals with distal polyneuropathy, which leads to damage to bones and joints. Most often, Charcot’s foot is formed in patients with diabetes mellitus (DM) and affects the foot and ankle joint. Diabetic neuroosteoarthropathy (DNOAP) is divided into active and inactive stages. The typical clinical picture of the active stage of diabetic neuroosteoarthropathy is edema and hyperemia of the affected foot, with a temperature gradient of more than 2 °C compared with an unaffected foot. The nonspecific clinical picture of the active stage of diabetic neuroosteoarthropathy makes it difficult to diagnose and often leads to the need for differential diagnosis of the active stage of diabetic neuroosteoarthropathy and osteomyelitis, which is one of the most difficult issues in clinical practice. Early detection of these conditions is crucial, since treatment of the active stage of diabetic neuroosteoarthropathy can prevent irreversible deformity of the foot, and detection of osteomyelitis will allow timely antibiotic therapy. Signs of changes in bone and foot structures in the active stage of diabetic neuroosteoarthropathy in images obtained by computer X-ray, magnetic resonance and emission tomography may be similar to signs of osteomyelitis, which determines the importance of choosing an imaging method when examining a patient and developing an effective algorithm for early diagnosis of DNOAP. In this review, the main attention will be paid to the distinctive features of the active stage of diabetic neuroosteoarthropathy and osteomyelitis when using imaging research methods.","PeriodicalId":518511,"journal":{"name":"Endocrine Surgery","volume":"43 12","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Differential diagnosis of diabetic neuroosteoarthropathy and osteomyelitis using medical imaging techniques\",\"authors\":\"Ya. V. Dvoryanchikov, A. Y. Tokmakova, G. Galstyan, M. S. Sheremeta, A. A. Trukhin\",\"doi\":\"10.14341/serg12842\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"According to modern concepts, Charcot’s neuro-osteoarthropathy (Charcot’s foot) is considered as an aseptic inflammatory process in individuals with distal polyneuropathy, which leads to damage to bones and joints. Most often, Charcot’s foot is formed in patients with diabetes mellitus (DM) and affects the foot and ankle joint. Diabetic neuroosteoarthropathy (DNOAP) is divided into active and inactive stages. The typical clinical picture of the active stage of diabetic neuroosteoarthropathy is edema and hyperemia of the affected foot, with a temperature gradient of more than 2 °C compared with an unaffected foot. The nonspecific clinical picture of the active stage of diabetic neuroosteoarthropathy makes it difficult to diagnose and often leads to the need for differential diagnosis of the active stage of diabetic neuroosteoarthropathy and osteomyelitis, which is one of the most difficult issues in clinical practice. Early detection of these conditions is crucial, since treatment of the active stage of diabetic neuroosteoarthropathy can prevent irreversible deformity of the foot, and detection of osteomyelitis will allow timely antibiotic therapy. Signs of changes in bone and foot structures in the active stage of diabetic neuroosteoarthropathy in images obtained by computer X-ray, magnetic resonance and emission tomography may be similar to signs of osteomyelitis, which determines the importance of choosing an imaging method when examining a patient and developing an effective algorithm for early diagnosis of DNOAP. In this review, the main attention will be paid to the distinctive features of the active stage of diabetic neuroosteoarthropathy and osteomyelitis when using imaging research methods.\",\"PeriodicalId\":518511,\"journal\":{\"name\":\"Endocrine Surgery\",\"volume\":\"43 12\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-07-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Endocrine Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14341/serg12842\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endocrine Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14341/serg12842","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
根据现代概念,夏科氏神经骨关节病(夏科氏足)被认为是远端多发性神经病患者的一种无菌性炎症过程,会导致骨骼和关节受损。沙尔科氏足多见于糖尿病(DM)患者,影响足部和踝关节。糖尿病神经骨关节病(DNOAP)分为活动期和非活动期。糖尿病神经性骨关节病活动期的典型临床表现是患足水肿和充血,与未受影响的足相比,温度梯度超过 2°C。糖尿病神经性关节病活动期的临床表现无特异性,因此很难诊断,往往需要对糖尿病神经性关节病活动期和骨髓炎进行鉴别诊断,这是临床实践中最棘手的问题之一。早期发现这些病症至关重要,因为治疗处于活动期的糖尿病神经性关节病可以防止足部出现不可逆转的畸形,而发现骨髓炎则可以及时进行抗生素治疗。在糖尿病神经性关节病的活动期,计算机 X 射线、磁共振和发射断层扫描获得的图像中骨和足部结构的变化迹象可能与骨髓炎的迹象相似,这就决定了在检查患者时选择成像方法和制定早期诊断 DNOAP 的有效算法的重要性。在这篇综述中,将主要关注在使用影像学研究方法时,糖尿病神经性关节病和骨髓炎活动期的明显特征。
Differential diagnosis of diabetic neuroosteoarthropathy and osteomyelitis using medical imaging techniques
According to modern concepts, Charcot’s neuro-osteoarthropathy (Charcot’s foot) is considered as an aseptic inflammatory process in individuals with distal polyneuropathy, which leads to damage to bones and joints. Most often, Charcot’s foot is formed in patients with diabetes mellitus (DM) and affects the foot and ankle joint. Diabetic neuroosteoarthropathy (DNOAP) is divided into active and inactive stages. The typical clinical picture of the active stage of diabetic neuroosteoarthropathy is edema and hyperemia of the affected foot, with a temperature gradient of more than 2 °C compared with an unaffected foot. The nonspecific clinical picture of the active stage of diabetic neuroosteoarthropathy makes it difficult to diagnose and often leads to the need for differential diagnosis of the active stage of diabetic neuroosteoarthropathy and osteomyelitis, which is one of the most difficult issues in clinical practice. Early detection of these conditions is crucial, since treatment of the active stage of diabetic neuroosteoarthropathy can prevent irreversible deformity of the foot, and detection of osteomyelitis will allow timely antibiotic therapy. Signs of changes in bone and foot structures in the active stage of diabetic neuroosteoarthropathy in images obtained by computer X-ray, magnetic resonance and emission tomography may be similar to signs of osteomyelitis, which determines the importance of choosing an imaging method when examining a patient and developing an effective algorithm for early diagnosis of DNOAP. In this review, the main attention will be paid to the distinctive features of the active stage of diabetic neuroosteoarthropathy and osteomyelitis when using imaging research methods.