Department of Diabetes and Endocrinology, Derby Hospitals NHS Trust, Uttoxeter Road, Derby DE22 3NE, UK.
Med Clin North Am. 2013 Sep;97(5):947-56. doi: 10.1016/j.mcna.2013.03.010. Epub 2013 May 4.
Although osteomyelitis of the foot in diabetes remains common in specialist foot clinics across the world, the quality of published work to guide clinicians in the diagnosis and management is generally poor. Diagnosis should be based primarily on clinical signs supported by results of pathologic and radiologic investigations. Although the gold standard comes from the histologic and microbiological examination of bone, clinicians should be aware of the problems of sampling error. This lack of standardization of diagnostic criteria and of consensus on the choice of outcome measures poses further difficulties when seeking evidence to support management decisions. Experts have traditionally recommended surgical removal of infected bone but available evidence suggests that in many cases (excepting those in whom immediate surgery is required to save life or limb) a nonsurgical approach to management of osteomyelitis may be effective for many, if not most, patients with osteomyelitis of the diabetic foot. The benefits and limitations of both approaches need, however, to be established in prospective trials so that appropriate therapy can be offered to appropriate patients at the appropriate time, with the patients' views taken fully into account.
尽管糖尿病足骨髓炎在世界各地的专科足病诊所仍然很常见，但指导临床医生进行诊断和治疗的已发表文献的质量通常较差。诊断应主要基于临床体征，并辅以病理和影像学检查结果。虽然金标准来自骨的组织学和微生物学检查，但临床医生应该意识到取样误差的问题。当寻求证据来支持管理决策时，诊断标准缺乏标准化以及对结果测量选择的共识进一步增加了困难。专家传统上建议手术切除感染的骨骼，但现有证据表明，在许多情况下（除了需要立即手术以挽救生命或肢体的情况外），对于大多数糖尿病足骨髓炎患者，非手术方法管理骨髓炎可能是有效的。然而，需要在前瞻性试验中确定这两种方法的益处和局限性，以便在适当的时间为适当的患者提供适当的治疗，并充分考虑患者的观点。
