Bone mineral density during total contact cast immobilization for a patient with neuropathic (Charcot) arthropathy
Bone mineral density during total contact cast immobilization for a patient with neuropathic (Charcot) arthropathy
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DOI：
10.1093/ptj/85.3.249
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发表时间：
2005-03-01
期刊：
影响因子：
3.2
通讯作者：
Johnson, JF
中科院分区：
文献类型：
--
作者：
Hastings, MK;Sinacore, DR;Johnson, JF
背景和目的。糖尿病(DM)相关的神经性足关节病变是一个破坏性的骨和关节过程。石膏固定和不负重对骨丢失的影响尚未得到很好的研究。本病例报告的目的是描述一个急性神经性关节病患者在全接触石膏固定过程中跟骨骨密度的变化。案例描述。患者是一位34岁的女性，患有1型DNI，肾功能衰竭需要透析，并患有7周的神经性足中关节病变。干预措施包括完全接触铸型和10周内最小或几乎没有负重，并过渡到治疗性鞋。超声对受累和非受累跟骨的骨密度进行了估算。结果。铸造过程中患足骨密度下降(从0.25g/cm(2)降至0.20g/cm(2))，健足骨密度(从0.27g/cm(2)升至0.31g/cm(2))。讨论。较低的初始骨密度和铸型过程中的进一步丢失表明有必要进行过渡性支撑和充分监测恢复充分活动，以最大限度地减少足部畸形复发和进展的风险。
Background and Purpose. Diabetes mellitus (DM)-related neuropathic arthropathy of the foot is a destructive bone and joint process. The effect of cast immobilization and non-weight bearing on bone loss has not been well studied. The purpose of this case report is to describe the changes in bone mineral density (BMD) of the calcaneus in the feet of a patient with acute neuropathic arthropathy during total contact cast immobilization. Case Description. The patient was a 34-year-old woman with type 1 DNI, renal failure requiring dialysis, and a 7-week duration of neuropathic arthropathy of the midfoot. Intervention included total contact casting and minimal to no weight bearing for 10 weeks, with transition to therapeutic footwear. Ultrasound-derived estimates of BMD were taken of both involved and uninvolved calcanei. Outcome. Bone mineral density decreased for the involved foot (from 0.25 g/cm(2) to 0.20 g/cm(2)) and increased for the uninvolved foot (from 0.27 g/cm(2) to 0.31 g/cm(2)) during casting. Discussion. The low initial BMD and further loss during casting suggest the need for transitional bracing and a well-monitored return to full activity to minimize the risk of recurrence and progression of foot deformity.