Zimny Stefan, Schatz Helmut, Pfohl Martin
Berufsgenossenschaftliche Kliniken Bergmannsheil Universitätsklinik, Ruhr-Universität Bochum, Medizinische Klinik und Poliklinik, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany.
J Diabetes Complications. 2002 Sep-Oct;16(5):327-32. doi: 10.1016/s1056-8727(01)00217-3.
To assess the wound size reduction and time course for healing and to establish equations to predict the time course of wound healing in neuropathic, neuroischemic, and ischemic diabetic foot ulcers.
This prospective study evaluates wound healing over at least a 10-week period in 31 Type 1 or Type 2 diabetic patients with plantar foot ulcers. Thirteen consecutive diabetic patients with neuropathic foot ulceration, 10 consecutive diabetic patients with neuroischemic ulceration, and 8 diabetic patients with peripheral occlusive vascular disease were selected for the study. All patients received identical ulcer wound care including use of proper footwear, non-weight-bearing limb support, use of appropriate antibiotics, debridement, tight control of serum glucose levels, and careful monitoring of the ulcer. Ulcer healing was assessed by planimetric measurement of the wound area every second week until wound healing. The time course of wound healing was calculated by the daily wound radius reduction.
The wound area (mean+/-S.E.) in the patients with neuropathic foot ulceration was 61.2+/-17.1 at the beginning and 3.2+/-1.5 mm(2) after 70 days (P=.005). The wound radius decreased by 0.045 mm (95% confidence interval [CI] 0.039-0.055) per day, with most of the wound healing being achieved between the first and seventh week of ulcer care. The average healing time was 77.7 (95% CI 62-93) days. In the neuroischemic group, the initial average wound area was 26.6+/-7.0 mm(2), and 6.25+/-1.7 mm(2) after 10 weeks (P=.007). The wound radius reduction was 0.019 mm/day (95% CI 0.017-0.023) with an average healing time of 123.4 (95% CI 101-145) days. The diabetic patients with peripheral occlusive vascular disease had an average wound size of 32.6+/-13.1 at the beginning and 23.9+/-10.7 mm(2) after 70 days of ulcer care (P=.06). The daily wound radius reduction was 0.0065 mm (95% CI 0.0039-0.0091). Average ulcer duration was 133 (95% CI 116-149) days, but three of eight patients achieved no wound healing.
Providing standard care, the time course of wound healing in diabetic foot ulcers is predominantly determined by etiologic factors, and less by wound size. Taking wound etiology and wound radius into account, the expected healing time can reliably be estimated in neuropathic and neuroischemic ulcers.
评估伤口大小的缩小情况及愈合的时间进程，并建立方程以预测神经性、神经缺血性和缺血性糖尿病足溃疡的伤口愈合时间进程。
这项前瞻性研究评估了31例患有足底溃疡的1型或2型糖尿病患者至少10周的伤口愈合情况。选择了13例连续性患有神经性足部溃疡的糖尿病患者、10例连续性患有神经缺血性溃疡的糖尿病患者以及8例患有周围闭塞性血管疾病的糖尿病患者进行研究。所有患者均接受相同的溃疡伤口护理，包括使用合适的鞋具、非负重肢体支撑、使用适当的抗生素、清创、严格控制血糖水平以及仔细监测溃疡情况。每隔一周通过平面测量伤口面积来评估溃疡愈合情况，直至伤口愈合。通过每日伤口半径缩小情况来计算伤口愈合的时间进程。
神经性足部溃疡患者的伤口面积（均值±标准误）在开始时为61.2±17.1，70天后为3.2±1.5平方毫米（P = 0.005）。伤口半径每天缩小0.045毫米（95%置信区间[CI] 0.039 - 0.055），大部分伤口愈合在溃疡护理的第一周和第七周之间实现。平均愈合时间为77.7（95% CI 62 - 93）天。在神经缺血性组中，初始平均伤口面积为26.6±7.0平方毫米，10周后为6.25±1.7平方毫米（P = 0.007）。伤口半径缩小为0.019毫米/天（95% CI 0.017 - 0.023），平均愈合时间为123.4（95% CI 101 - 145）天。患有周围闭塞性血管疾病的糖尿病患者初始平均伤口大小为32.6±13.1，溃疡护理70天后为23.9±10.7平方毫米（P = 0.06）。每日伤口半径缩小为0.0065毫米（95% CI 0.0039 - 0.0091）。平均溃疡持续时间为133（95% CI 116 - 149）天，但8例患者中有3例未实现伤口愈合。
在提供标准护理的情况下，糖尿病足溃疡的伤口愈合时间进程主要由病因因素决定，而较少受伤口大小影响。考虑伤口病因和伤口半径，在神经性和神经缺血性溃疡中可以可靠地估计预期愈合时间。
