Musa A A
Dept. of Orthopaedics, Usmanu danfodiyo university teaching hospital, p.m.b.2370, Sokoto, Nigeria.
East Afr J Public Health. 2012 Mar;9(1):50-2.
Diabetic foot syndrome is a complication of diabetes mellitus that has serious socioeconomic implications for the individual, family and the society as a whole. When there are ulcers, the condition becomes limb threatening. Early detection of the risk factors and appropriate management of the ulcers reduces the incidence of amputations, morbidity and mortality.
To find the pattern of diabetic foot laesions (DFL) as seen at the orthopaedic clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria over a five-year period and to present a classification of DFL.
From June 2006 to June 2011 diabetics who had complaints arising from their feet were referred to the orthopaedic clinic at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. At presentation each patient was examined and investigated. Each foot was examined thoroughly and all the laesions were documented and graded according to Wagner's classification. Out come of management of the cases of DFL was also recorded. All the data collected was analysed.
Two groups (A and B) of patients were identified. In group (A) were patients in whom there was good renal function, no septicaemia, mean value of fasting blood glucose most often was < or = 14 mmol/l. In this group only the feet were threatened. There was a second group (B) in whom there was septicaemia, mean value of fasting blood glucose most often was < or = 15 mmol/l, and impaired renal function (ketone bodies were identified in urine, high serum levels of urea and creatine). Most of these patients had gangrene of the whole foot. In some of the patients infections extended into the gastrosnemius muscle. In diabetic foot laesions grades 0-3, no part of the foot was amputated. In diabetic foot laesions grade 4, infections were controlled and part of the foot had to be amputated. In diabetic foot laesions grade 5, infections were controlled with difficulty and there were systemic symptoms. Amputation of the whole foot was always indicated in this group of patients. The level of amputation most often was far above the ankle joint, either below or above knee.
Outcome of treatment revealed three groups of feet. There were salvageable, difficult to salvage and unsalvageable feet. These three outcomes of treatment of diabetic foot lesions formed the basis of a new grading system: gradel (salvageable), grade 2 (difficult to salvage) and grade 3 (unsalvageable). The condition of the patient determines the urgency, extent of intervention and length of stay in the hospital.
糖尿病足综合征是糖尿病的一种并发症，对个人、家庭乃至整个社会都具有严重的社会经济影响。当出现溃疡时，病情会对肢体构成威胁。早期发现危险因素并对溃疡进行适当处理可降低截肢率、发病率和死亡率。
了解尼日利亚索科托乌斯曼努·丹福迪奥大学教学医院骨科门诊在五年期间所见到的糖尿病足病变（DFL）模式，并提出DFL的分类方法。
2006年6月至2011年6月，足部出现问题的糖尿病患者被转诊至尼日利亚索科托乌斯曼努·丹福迪奥大学教学医院骨科门诊。患者就诊时均接受检查和调查。对每只脚进行全面检查，所有病变均记录在案，并根据瓦格纳分类法进行分级。还记录了DFL病例的治疗结果。对收集到的所有数据进行分析。
确定了两组患者（A组和B组）。A组患者肾功能良好，无败血症，空腹血糖平均值大多≤14 mmol/L。该组仅足部受到威胁。B组患者有败血症，空腹血糖平均值大多≤15 mmol/L，且肾功能受损（尿中检出酮体，血清尿素和肌酐水平升高）。这些患者大多足部发生坏疽。部分患者感染蔓延至腓肠肌。在0 - 3级糖尿病足病变中，足部未进行截肢。在4级糖尿病足病变中，感染得到控制，但足部部分组织不得不被截肢。在5级糖尿病足病变中，感染难以控制且出现全身症状。该组患者通常需要进行全足截肢。截肢平面大多在踝关节上方很远的位置，要么在膝关节下方，要么在膝关节上方。
治疗结果显示有三类足部情况。分别是可挽救的、难以挽救的和无法挽救的足部。糖尿病足病变的这三种治疗结果构成了一种新的分级系统的基础：1级（可挽救）、2级（难以挽救）和3级（无法挽救）。患者的病情决定了干预的紧迫性、范围以及住院时间。
