Cecilia-Matilla Almudena, Lázaro-Martínez José Luis, Aragón-Sánchez Javier, García-Morales Esther, García-Álvarez Yolanda, Beneit-Montesinos Juan Vicente
Unidad de Pie Diabético, Clínica Universitaria de Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
J Am Podiatr Med Assoc. 2013 Jan-Feb;103(1):24-31. doi: 10.7547/1030024.
A universally accepted histopathologic classification of diabetic foot osteomyelitis does not currently exist. We sought to evaluate the histopathologic characteristics of bone infection found in the feet of diabetic patients and to analyze the clinical variables related to each type of bone infection.
We conducted an observational prospective study of 165 diabetic patients with foot ulcers who underwent surgery for bone infection. Samples for microbiological and histopathologic analyses were collected in the operating room under sterile conditions.
We found four histopathologic types of osteomyelitis: acute osteomyelitis (n = 46; 27.9%), chronic osteomyelitis (n = 73; 44.2%), chronic acute osteomyelitis (n = 14; 8.5%), and fibrosis (n =32; 19.4%). The mean ± SD time between the initial detection of ulcer and surgery was 15.4 ± 23 weeks for acute osteomyelitis, 28.6 ± 22.4 weeks for chronic osteomyelitis, 35 ± 31.3 weeks for chronic acute osteomyelitis, and 27.5 ± 27.3 weeks for the fibrosis stage (analysis of variance: P = .03). Bacteria were isolated and identified in 40 of 46 patients (87.0%) with acute osteomyelitis, 61 of 73 (83.5%) with chronic osteomyelitis, 11 of 14 (78.6%) with chronic acute osteomyelitis, and 25 of 32 (78.1%) with fibrosis.
Histopathologic categorization of bone infections in the feet of diabetic patients should include four groups: acute, chronic, chronic acute, and fibrosis. We suggest that new studies should identify cases of fibrosis to allow comparison with the present results.
目前尚无普遍接受的糖尿病足骨髓炎组织病理学分类。我们试图评估糖尿病患者足部骨感染的组织病理学特征，并分析与每种骨感染类型相关的临床变量。
我们对165例因骨感染接受手术的糖尿病足溃疡患者进行了一项前瞻性观察研究。在手术室无菌条件下采集微生物学和组织病理学分析样本。
我们发现了四种骨髓炎的组织病理学类型：急性骨髓炎（n = 46；27.9%）、慢性骨髓炎（n = 73；44.2%）、慢性急性骨髓炎（n = 14；8.5%）和纤维化（n = 32；19.4%）。急性骨髓炎从溃疡最初发现到手术的平均±标准差时间为15.4±23周，慢性骨髓炎为28.6±22.4周，慢性急性骨髓炎为35±31.3周，纤维化阶段为27.5±27.3周（方差分析：P = 0.03）。46例急性骨髓炎患者中有40例（87.0%）分离并鉴定出细菌，73例慢性骨髓炎患者中有61例（83.5%），14例慢性急性骨髓炎患者中有11例（78.6%），32例纤维化患者中有25例（78.1%）。
糖尿病患者足部骨感染的组织病理学分类应包括四组：急性、慢性、慢性急性和纤维化。我们建议新的研究应识别纤维化病例，以便与目前的结果进行比较。
