(精选)november2011theone教学课件.pptVIP

* * * * * Treatment of Charcot Arthropathy Mean time in casts 2001, 33.6 weeks (8 - 56) 2006, 20.5 weeks (range 8 - 30) (p0.001) Mean time from active to quiescence 2001, 42 weeks (8 -70) 2006, 26.3 weeks (range 8 – 40) (p0.001) 39 (87%) 4 (9%) 2 (4%) Outcomesn=45 No. of C.N.A Surgery - exostectomies and minor amputations Below Knee Amputation Deaths Healed/ Stable Feet 31 0 0 7 Feet with Ulcers 14 5+4 4 2 Mortality/Morbidity Charcot v Matched Controls (p0.05) Summary Charcot Arthropathy IS uncommon (1:500 people with diabetes) Diagnosis is often initially delayed, but community education and awareness significantly reduces this Poor diabetic control appears to be a prerequisite for CNA Conclusion Earlier recognition and treatment of C.N.A. translates into significantly faster healing 3/12`s less time in casts! (Charcot “Road shows” work!) Our local surgical practice is conservative reserved for feet with recurrent or non healing ulcers only Outcome for both limb and life is NOT adversely affected. Larger patient numbers are needed to be studied to ratify these findings and this will demand collaborative working e.g. CDUK Grant from DUKThe Charcot register National data base Lead and managed from ELHT The Charcot Register Scotland 6 North East 4 North West 10 Yorkshire Humberside 4 West Midlands 3 East Midlands 6 Northern Ireland 1 Republic of Ireland 2 Wales 4 East Anglia 5 South West 10 South East 16 Finally Latest Benchmarking Data from the SHA Lowest non-elective admission rates Shortest length of stay Effective and efficient service Diabetic Foot Service Then now 1988 People working in isolat