Hartemann-Heurtier Agnès, Ha Van Georges
Service de diabétologie Groupe hospitalier La Pitié-La Salpêtrière 75651 Paris.
Rev Prat. 2003 May 15;53(10):1102-8.
Diabetic patients are concerned with foot complications when a peripheral neuropathy is present. Screening of predisposed patients may be annually assessed using monofilament testing. Peripheral arterial disease, when associated, increases amputation risk. Ideal treatment requires a multidisciplinary approach with a first-line medical treatment including an optimal off-loading of the diabetic ulcer, ulcer dertersion, glycemic control, and if necessary antibiotic therapy. In case of associated osteomyelitis, a limited surgical resection of the infected bone may be performed. In case of associated arterial disease, a revascularization procedure precede bone resection.
糖尿病患者出现周围神经病变时会担心足部并发症。对于易患患者,可每年使用单丝测试进行筛查。若伴有外周动脉疾病,则截肢风险会增加。理想的治疗需要多学科方法,一线药物治疗包括对糖尿病溃疡进行最佳减压、溃疡清创、血糖控制,必要时进行抗生素治疗。若伴有骨髓炎,可对感染骨进行有限的手术切除。若伴有动脉疾病,则在骨切除前先进行血管重建手术。