Bahebeck Jean, Sobgui Eugene, Loic Fonkoue, Nonga Bernadette Ngo, Mbanya Jean Claude, Sosso Maurice
Central Hospital of Yaoundé, Faculty of Medicine, University of Yaoundé I, Cameroun.
J Foot Ankle Surg. 2010 Jan-Feb;49(1):43-6. doi: 10.1053/j.jfas.2009.08.011.
Limb- and life-threatening hand and foot infections in diabetic patients account for a large proportion of amputations and a substantial number of deaths. Between August 2006 and the end of July 2008, we conducted a prospective cohort study of consecutive diabetic patients with serious hand or foot infections, in an effort to identify clinical patterns and outcomes related to the treatment of these infections. Infections were categorized as dry, gas, and wet gangrene; necrotizing fasciitis or cellulitis; acute extensive osteomyelitis; and any of these infections involving the hand. All of the patients underwent a standard examination and treatment protocol, although none of the patients received vascular surgical care. End points included healing following debridement or minor amputation, major (transtibial or more proximal) amputation, or death. A total of 56 patients were included in the final analyses, and their mean age was 70 (range 51 to 86) years. Of the patients, 17 (30.36%) had necrotizing cellulitis, 12 (21.43%) had wet gangrene, 9 (16.07%) had acute extensive osteomyelitis, 5 (8.93%) had dry gangrene, 5 (8.93%) had gas gangrene, 4 (7.14%) had necrotizing fasciitis, and 4 (7.14) had diffuse hand infections. Five (8.93%) patients died (2 after prior amputation), 26 (46.43%) underwent debridement and/or minor amputation, and 27 (48.21%) required major amputations. Based on our findings, we concluded that 7 patterns of serious limb- or life-threatening infection were identified and, in the absence of vascular surgical intervention, mortality can be reduced at the expense of more amputations.
糖尿病患者中危及肢体和生命的手足感染占截肢手术的很大比例，并且导致大量死亡。在2006年8月至2008年7月底期间，我们对连续性的患有严重手足感染的糖尿病患者进行了一项前瞻性队列研究，旨在确定与这些感染治疗相关的临床模式和结局。感染分为干性、气性和湿性坏疽；坏死性筋膜炎或蜂窝织炎；急性广泛性骨髓炎；以及涉及手部的上述任何一种感染。所有患者均接受了标准检查和治疗方案，尽管没有患者接受血管外科治疗。终点包括清创或小截肢术后愈合、大截肢（经胫骨或更近端）或死亡。最终分析共纳入56例患者，他们的平均年龄为70岁（范围51至86岁）。其中，17例（30.36%）患有坏死性蜂窝织炎，12例（21.43%）患有湿性坏疽，9例（16.07%）患有急性广泛性骨髓炎，5例（8.93%）患有干性坏疽，5例（8.93%）患有气性坏疽，4例（7.14%）患有坏死性筋膜炎，4例（7.14%）患有弥漫性手部感染。5例（8.93%）患者死亡（2例在截肢前死亡），26例（46.43%）接受了清创和/或小截肢，27例（48.21%）需要进行大截肢。根据我们的研究结果，我们得出结论，确定了7种严重的危及肢体或生命的感染模式，并且在没有血管外科干预的情况下，可以通过更多的截肢来降低死亡率。
