Kästenbauer T, Sauseng S
Ludwig Boltzmann Institut für Stoffwechselerkrankungen und Ernährung, Krankenhaus Wien-Lainz, Wolkersbergenstrasse 1, A-1130 Wien.
Acta Med Austriaca. 1999;26(5):173-7.
Diabetic foot ulcers develop at high pressure sites, whereby causal factors for increased plantar pressure are insufficiently investigated. We clinically inspected the feet of 186 Type 2-diabetic patients and measured peripheral neuropathy and plantar pressure during walking. Subjects were assigned into a group with normal (n = 113) and elevated (n = 73) plantar pressure. In patients with elevated plantar pressure body weight was significantly increased (85.4 +/- 12.3 kg vs. 80.7 +/- 13.8), as was plantar pressure increased at the hallux (519 +/- 322 kPa vs. 346 +/- 154), at the metatarsal head I (MTH) I (442 +/- 270 vs. 235 +/- 95) and at the MTH II-V (788 +/- 277 vs. 446 +/- 145). The vibration perception threshold was significantly higher among these patients (21.8 +/- 11.0 Volt vs. 16.7 +/- 9.0), as was the prevalence of hyperkeratosis (69.9% vs. 43.4) and clawed toes (28.8% vs. 15.9). In a multiple regression analysis, hyperkeratosis (Beta = 0.25, p < 0.001) and body weight (Beta = 0.27, p < 0.001) were significant risk factors, but did not describe the whole variation of plantar pressure in the multivariate model. Limited joint mobility (LJM), which was not measured but estimated in the present study, was slightly more prevalent among patients with elevated plantar pressures (46.6 vs. 33.6%). It could be assumed, that LJM, if exactly measured, is a significant risk factor in a multivariate analysis, too.
糖尿病足溃疡在高压部位形成，然而对于足底压力增加的病因因素研究尚不充分。我们对186例2型糖尿病患者的足部进行了临床检查，并测量了他们行走时的周围神经病变和足底压力。受试者被分为足底压力正常组（n = 113）和足底压力升高组（n = 73）。足底压力升高的患者体重显著增加（85.4±12.3千克 vs. 80.7±13.8千克），拇趾处的足底压力也升高（519±322千帕 vs. 346±154千帕），第一跖骨头处（MTH）I（442±270 vs. 235±95）以及第二至五跖骨头处（788±277 vs. 446±145）的足底压力同样升高。这些患者的振动觉阈值显著更高（21.8±11.0伏特 vs. 16.7±9.0），角化过度的患病率（69.9% vs. 43.4%）以及爪形趾的患病率（28.8% vs. 15.9%）也是如此。在多元回归分析中，角化过度（β = 0.25，p < 0.001）和体重（β = 0.27，p < 0.001）是显著的危险因素，但在多变量模型中并不能描述足底压力的全部变化情况。本研究中未进行测量但估计的关节活动受限（LJM）在足底压力升高的患者中略为常见（46.6% vs. 33.6%）。可以推测，如果准确测量，LJM在多变量分析中也是一个显著的危险因素。
