Van Damme H, Limet R
Service de Chirurgie Cardio-Vasculaire et Thoracique, CHU Sart Tilman, Liège.
Rev Med Liege. 2005 May-Jun;60(5-6):516-25.
The pathophysiological mechanisms underlying a diabetic foot disease are complex and multifactorial, including neuropathy, ischemia, infection and abnormal foot biomechanics. All these factors are often intricated and source of delayed wound healing. Insight in the pathophysiology of the diabetic foot provides a comprehensive basis for a protocol of primary and secondary preventive care. Since non-enzymatic glycosilation of proteins and of connective tissue underlies structural changes in vessels, nerves and osteo-articular structures, a rigid control of blood glucose levels is of paramount importance. Early recognition of the etiology of foot lesions and prompt management of foot ulcers are essential for successful outcome. Aggressive treatment of infections, clinical assessment and correction of vascular occlusive disease (diabetic macroangiopathy), adequate wound care and appropriate off-loading (pressure relief) of the ulcer are essential steps in the treatment protocol. It is not surprising that optimal management of the diabetic foot requires a multidisciplinary approach in a Diabetic Foot Clinic, coordinating care-provisions by a team of diabetologist, infectiologist, vascular surgeon, interventional radiologist, plastic surgeon, podiatrist and specialized nurse. Applying evidence-based multidisciplinary treatment results in a 50% reduction of major lower-limb amputation in this high risk group.
糖尿病足病的病理生理机制复杂且多因素，包括神经病变、缺血、感染和足部生物力学异常。所有这些因素常常相互交织，是伤口愈合延迟的原因。深入了解糖尿病足的病理生理学为一级和二级预防护理方案提供了全面的基础。由于蛋白质和结缔组织的非酶糖基化是血管、神经和骨关节结构发生结构变化的基础，严格控制血糖水平至关重要。早期识别足部病变的病因并及时处理足部溃疡对于取得成功的结果至关重要。积极治疗感染、临床评估和纠正血管闭塞性疾病（糖尿病大血管病变）、适当的伤口护理以及对溃疡进行适当的减负（减压）是治疗方案中的关键步骤。毫不奇怪，糖尿病足的最佳管理需要在糖尿病足诊所采用多学科方法，由糖尿病专家、感染病专家、血管外科医生、介入放射科医生、整形外科医生、足病医生和专科护士组成的团队协调护理工作。应用基于证据的多学科治疗可使该高危组的主要下肢截肢率降低50%。
