Baykal Yakup Barbaros, Yaman Emre, Burc Halil, Yorgancigil Huseyin, Atay Tolga, Yıldız Mustafa
J Am Podiatr Med Assoc. 2014 May;104(3):227-32. doi: 10.7547/0003-0538-104.3.227.
In this study, we aimed to evaluate the potential use of a 3-phase bone scintigraphy method to determine the level of amputation on treatment cost, morbidity and mortality, reamputation rates, and the duration of hospitalization in diabetic foot.
Thirty patients who were admitted to our clinic between September 2008 and July 2009, with diabetic foot were included. All patients were evaluated according to age, gender, diabetes duration, 3-phase bone scintigraphy, Doppler ultrasound, amputation/reamputation levels, and hospitalization periods. Patients underwent 3-phase bone scintigraphy using technetium-99m methylene diphosphonate, and the most distal site of the region displaying perfusion during the perfusion and early blood flow phase was marked as the amputation level. Amputation level was determined by 3-phase bone scintigraphy, Doppler ultrasound, and inspection of the infection-free clear region during surgery.
The amputation levels of the patients were as follows: finger in six (20%), ray amputation in five (16.6%), transmetatarsal in one (3.3%), Lisfranc in two (6.6%), Chopart in seven (23.3%), Syme in one (3.3%), below-the-knee in six (20%), above the knee in one (3.3%), knee disarticulation in one (3.3%), and two patients underwent amputation at other centers. After primary amputation, reamputation was performed on seven patients, and one patient was treated with debridement for wound site problems. No mortality was encountered during study.
We conclude that 3-phase bone scintigraphy prior to surgery could be a useful method to determine the amputation level in a diabetic foot. We conclude that further, comparative, more comprehensive, long-term, and controlled studies are required.
在本研究中，我们旨在评估三相骨闪烁显像法在确定截肢水平对糖尿病足治疗费用、发病率和死亡率、再次截肢率以及住院时间的潜在作用。
纳入2008年9月至2009年7月间收治于我院门诊的30例糖尿病足患者。所有患者均根据年龄、性别、糖尿病病程、三相骨闪烁显像、多普勒超声、截肢/再次截肢水平及住院时间进行评估。患者使用锝-99m亚甲基二膦酸盐进行三相骨闪烁显像，在灌注期和早期血流期显示灌注的区域最远端部位标记为截肢水平。截肢水平通过三相骨闪烁显像、多普勒超声以及手术中对无感染清洁区域的检查来确定。
患者的截肢水平如下：手指截肢6例（20%），射线截肢5例（16.6%），经跖骨截肢1例（3.3%），Lisfranc关节离断术2例（6.6%），Chopart关节离断术7例（23.3%），Syme截肢1例（3.3%），膝下截肢6例（20%），膝上截肢1例（3.3%），膝关节离断术1例（3.3%），2例患者在其他中心接受截肢。初次截肢后，7例患者进行了再次截肢，1例患者因伤口部位问题接受了清创治疗。研究期间未发生死亡病例。
我们得出结论，术前三相骨闪烁显像可能是确定糖尿病足截肢水平的一种有用方法。我们得出结论，需要进一步开展比较性、更全面、长期且有对照的研究。
