Accelerated Cortical Osteolysis of Metatarsals in Charcot Neuroarthropathy: A Cross-Sectional Observational Study.
Accelerated Cortical Osteolysis of Metatarsals in Charcot Neuroarthropathy: A Cross-Sectional Observational Study.
复制标题
夏科神经关节病跖骨加速皮质骨溶解：横断面观察研究。
DOI：
10.1002/jbm4.10243
复制
发表时间：
2019
期刊：
影响因子：
3.8
通讯作者：
Strube,MichaelJ
中科院分区：
文献类型：
--
作者：
Sinacore,DavidR;Smith,KirkE;Bohnert,KathrynL;Gutekunst,DavidJ;Johnson,JeffreyE;Strube,MichaelJ
跖骨是年轻运动员和老年人应力性和脆性骨折的常见部位。跖骨骨折在Charcot神经关节病（CN）中特别常见，这是糖尿病（DM）和周围神经病（PN）的并发症。神经性跖骨骨折可能由加速的皮质骨溶解引起，并可能反映为标准足部X线片的几何推导强度估计值。本横断面研究的目的是确定与非糖尿病和非神经病变的年轻和老年成人对照相比，DM、PN和CN患者跖骨的几何形状和强度估计值。我们研究了62名参与者：20名年轻人对照（YAC），22名老年人对照（OAC）和20名诊断为DMPN&CN的患者。通过负重X线片，我们测量了第二和第五跖骨骨干远端、中间和近端的骨干外径和骨髓内径。根据这些直径，我们得出了两个跖骨每个部位的组合皮质宽度（Cct.Wi）、皮质面积百分比（%Ct.rA）、屈曲比（BR）、惯性矩（MOI）和截面模量（SM）的强度估计值。与OAC和YAC相比，DMPN和CN参与者的皮质变薄加速，%Ct.Ar降低，BR增加，MOI和SM降低。OAC显示年龄相关的CCt.Wi和% Ct.Ar降低，BR增加。BR表现出显著的组×骨×部位相互作用，DMPN&CN组的远端第五跖骨骨强度最低。DMPN和CN参与者远端第五跖骨的BR分别比OAC和YAC组高36%和49%。DMPN&CN参与者与年轻和老年对照组相比，跖骨强度估计值较低。标准足部X线片显示DMPN和CN个体的皮质骨溶解加速，特别是在第五跖骨骨干远端。© 2019 The Authors.JBMR Plus由Wiley Periodicals，Inc.出版。代表美国骨与矿物质研究协会© 2019作者.JBMR Plus由Wiley Periodicals，Inc.出版。美国骨与矿物质研究协会（American Society for Bone and Mineral Research）
Metatarsals are frequent sites of stress and fragility fractures in younger athletic populations and aging older adults. Metatarsal fractures are particularly common in Charcot neuroarthropathy (CN), a complication of diabetes mellitus (DM) and peripheral neuropathy (PN). Neuropathic metatarsal fractures may be caused by an accelerated cortical bone osteolysis and may be reflected as geometric derived strength estimates from standard foot radiographs. The purpose of this cross sectional study was to determine geometry and strength derived estimates of the metatarsals in individuals with DM, PN, and CN compared with younger and older adult controls who were nondiabetic and nonneuropathic. We studied 62 participants: 20 young adult controls (YACs), 22 older adult controls (OACs), and 20 diagnosed with DMPN&CN. From weight bearing radiographs, we measured the outer diaphysis diameter and inner marrow diameter at the distal, middle, and proximal diaphysis sites of the second and fifth metatarsal. From these diameters, we derived strength estimates of combined cortical width (CCt.Wi), percent cortical area (%Ct.rA), buckling ratio (BR), moment of inertia (MOI), and section modulus (SM) at each site in both metatarsals. DMPN&CN participants had an accelerated cortical thinning, decreased %Ct.Ar, increased BR, and lower MOI and SM compared with OACs and YACs. The OACs showed age related decreases in CCt.Wi and % Ct.Ar, and increased BR. The BR demonstrated significant group × bone × site interaction with the distal fifth metatarsal in the DMPN&CN group having the lowest bone strength. The BR in the distal fifth metatarsal of DMPN&CN participants was 36% and 49% greater than in the OAC and YAC groups, respectively. DMPN&CN participants have lower metatarsal bone strength estimates compared with younger and older adult controls. Standard foot radiographs demonstrate an accelerated cortical osteolysis in DMPN&CN individuals, particularly in the distal fifth metatarsal diaphysis. © 2019 The Authors.JBMR Pluspublished by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research © 2019 The Authors.JBMR Pluspublished by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.