Sanz-Corbalán I, Lázaro-Martínez J L, García-Morales E, Aragón-Sánchez J, Carabantes-Alarcón D, García-Álvarez Y
Diabetic Foot Unit, Complutense University Clinic, Madrid, Spain.
Exp Clin Endocrinol Diabetes. 2013 Apr;121(4):239-43. doi: 10.1055/s-0032-1329981. Epub 2013 Jan 17.
The aim is to define the association of forefoot deformity and limited joint mobility in the ankle and hallux joints in patients with diabetes mellitus subject to different diagnostic tests for diabetic neuropathy. Prospective study with 118 type 2 diabetic patients (68 men, mean age of 65.6±9.9 years) enrolled consecutively from the Diabetic Foot Unit of the Complutense University of Madrid subject to evaluation of plantar surface sensitivity by 10-g Semmes-Weinstein Monofilament, vibratory threshold by biothesiometer, and sudomotor dysfunction by Neuropad®. The patients presented with limited joint mobility of the ankle and the first metatarsophalangeal joints, and forefoot deformities were registered. Statistical analysis was done through a univariate model to test the association between neurological and biomechanical alteration. There was an association of abnormal Monofilament (p=0.01; OR=3.9) and biothesiometer tests (p=0.01; OR=2.6) with the presence of forefoot deformity. Furthermore, a relation was found between abnormal Monofilament (p=0.02; OR=4.8) and biothesiometer (p<0.00; OR=12.8) tests with limited mobility of the first metatarsophalangeal joint both in loading and off-loading. Abnormal sudomotor function test was related with limited joint mobility of the ankle joint with the knee flexed (p=0.04; OR=2.8).
The results of this study show discordance between biomechanical abnormalities and neuropathy depending on the diagnostic test used. Tests that assess large myelinated nerve fibers are associated with the presence of deformities. Abnormal sudomotor function test is associated with limited joint mobility and this test has a greater capacity for selecting patients at risk.
旨在确定糖尿病患者中前足畸形与踝关节和拇趾关节活动受限之间的关联，这些患者需接受不同的糖尿病神经病变诊断测试。对来自马德里康普顿斯大学糖尿病足科的118例2型糖尿病患者（68名男性，平均年龄65.6±9.9岁）进行前瞻性研究，通过10克Semmes-Weinstein单丝评估足底表面敏感性，通过生物感觉阈值测量仪评估振动阈值，通过Neuropad®评估汗腺运动功能障碍。记录患者踝关节和第一跖趾关节活动受限以及前足畸形情况。通过单变量模型进行统计分析，以检验神经学和生物力学改变之间的关联。单丝异常（p=0.01；OR=3.9）和生物感觉阈值测量仪测试异常（p=0.01；OR=2.6）与前足畸形的存在相关。此外，发现单丝异常（p=0.02；OR=4.8）和生物感觉阈值测量仪测试异常（p<0.00；OR=12.8）与第一跖趾关节在负重和非负重状态下的活动受限均有关。汗腺运动功能测试异常与膝关节屈曲时踝关节活动受限相关（p=0.04；OR=2.8）。
本研究结果表明，根据所使用的诊断测试，生物力学异常与神经病变之间存在不一致。评估大的有髓神经纤维的测试与畸形的存在相关。汗腺运动功能测试异常与关节活动受限相关，并且该测试在筛选高危患者方面具有更大的能力。
