Petrakis I E, Sciacca V
First Department of General Surgery, Policlinico Umberto I, University of Rome, La Sapienza, Rome, Italy.
J Diabetes Complications. 1999 Sep-Dec;13(5-6):293-9. doi: 10.1016/s1056-8727(99)00061-6.
Spinal cord stimulation (SCS) has been suggested to improve microcirculatory blood flow to relieve ischemic pain and to reduce amputation rate in patients with peripheral arterial occlusive disease (PAOD). The aim of this study was to evaluate the specific prognostic parameters in the prediction of successful SCS, in diabetic patients, performing a retrospective data analysis. To perform this evaluation, 64 diabetic patients (39 men, 25 women; mean age, 69 years) classified as Fontaine's stage III and IV, with PAOD, were treated with SCS for rest pain and trophic lesions with dry gangrene, after failed conservative or surgical treatment. In clinical controls, pedal transcutaneous oxygen tension (TcPO(2)), ankle/brachial blood pressure index (ABI), and toe pressure Doppler measurements were utilized to select and follow-up the patients. After 58 months of follow-up (range, 20-128 months), pain relief greater than 75% and limb salvage were achieved in 38 diabetic patients. A partial success was obtained in nine patients with pain relief greater than 50% and limb salvage for at least 6 months. The method failed in 17 patients or the device was removed due to technical problems, and the limb was amputated in these patients. TcPO(2) was assessed on the dorsum of the foot. Clinical improvement and SCS success were associated with increase of TcPO(2), before and after implantation. Limb salvage was achieved in the patients who had significant TcPO(2) increase within the 2 weeks of the testing period, independently of the stage of the disease. A TcPO(2) increase of more than 50% in the first 2 months after implantation was predictive of success, and was related to the presence of adequate paresthesias in the painful area during the trial period. TcPO(2) significantly increased after long-term follow-up in all patients with limb salvage (from 22.1 to 43.1 mm Hg in the rest pain patients, from 15.8 to 36.4 mm Hg in those with trophic lesions of less than 3 cm(2), and from 12.1 to 28.1 in those with trophic lesions of greater than 3 cm(2), (p < 0.01). ABI did not changed under stimulation. In diabetic patients with PAOD, the SCS increases the skin blood flow, is associated with significant pain relief, and could be proven an excellent alternative therapy, improving the life quality. Significant TcPO(2) increase within the 2-week test period, is a predictive index of therapy success and should be considered before the final decision in terms of cost effectiveness, before the permanent implantation.
脊髓刺激（SCS）已被建议用于改善微循环血流，以缓解缺血性疼痛并降低外周动脉闭塞性疾病（PAOD）患者的截肢率。本研究的目的是通过进行回顾性数据分析，评估糖尿病患者中预测SCS成功的特定预后参数。为了进行这项评估，对64例被归类为Fontaine III期和IV期、患有PAOD的糖尿病患者（39例男性，25例女性；平均年龄69岁）进行了SCS治疗，用于缓解静息痛和伴有干性坏疽的营养性病变，此前保守或手术治疗均失败。在临床对照中，利用经皮足氧分压（TcPO₂）、踝/臂血压指数（ABI）和趾压多普勒测量来选择和随访患者。经过58个月的随访（范围为20 - 128个月），38例糖尿病患者实现了疼痛缓解超过75%且肢体保留。9例患者取得了部分成功，疼痛缓解超过50%且肢体保留至少6个月。该方法在17例患者中失败，或因技术问题移除了设备，这些患者的肢体被截肢。在足背评估TcPO₂。临床改善和SCS成功与植入前后TcPO₂的增加相关。在测试期2周内TcPO₂有显著增加的患者实现了肢体保留，与疾病阶段无关。植入后前2个月内TcPO₂增加超过50%可预测成功，并且与试验期疼痛区域出现足够的感觉异常有关。所有肢体保留的患者在长期随访后TcPO₂显著增加（静息痛患者从22.1 mmHg增至43.1 mmHg，营养性病变小于3 cm²的患者从15.8 mmHg增至36.4 mmHg，营养性病变大于3 cm²的患者从12.1 mmHg增至28.1 mmHg，（p < 0.01）。刺激下ABI未改变。在患有PAOD的糖尿病患者中，SCS增加皮肤血流，与显著的疼痛缓解相关，并且可以被证明是一种改善生活质量的优秀替代疗法。在2周测试期内TcPO₂显著增加是治疗成功的预测指标，在考虑成本效益进行最终决策、进行永久植入之前应予以考虑。
