Larsen K, Holstein P, Deckert T
Steno Memorial Hospital, Gentofte, Denmark.
Prosthet Orthot Int. 1989 Aug;13(2):100-3. doi: 10.3109/03093648909078221.
The healing results in 491 ulcers in 272 diabetic patients are reported. Soft moulded insoles and shoe corrections were the main part of the therapy. There were 329 (67%) neuropathic, 87 (17%) traumatic, 44 (9%) ischaemic and 31 (6%) ulcers of other various pathogenesis. Thirty seven per cent of the ulcers were complicated with invasive infection. Within the period of observation of 18 months (3-39 months) healing was obtained in 79% of the patients (88% of the ulcers) and major amputation was carried out in 8% (4% of the ulcers). There were 21 major amputations, which in 18 cases was due to ischaemia. Thus in only 3 cases (1% of the patients) neuropathy as complicated by invasive infection caused major amputation. Fifty nine ulcers (12%) were classified as relapsing ulcers or ulcers with new localizations and were caused by severe deformity of the foot (58 cases) often in combination with neglect of prophylaxis (7 cases). Only one recurrent ulcer was caused by ischaemia. The series shows that shoe corrections and insoles are effective in treating diabetic neuropathic ulcers. Recurrent ulcerations are caused by severe foot deformity and neglect of therapy. Loss of limbs is caused by ischaemia and invasive infection.
报告了272例糖尿病患者491处溃疡的愈合结果。柔软的模制鞋垫和鞋具矫正为治疗的主要部分。其中329处（67%）为神经性溃疡，87处（17%）为创伤性溃疡，44处（9%）为缺血性溃疡，31处（6%）为其他各种病因的溃疡。37%的溃疡合并侵袭性感染。在18个月（3 - 39个月）的观察期内，79%的患者（88%的溃疡）实现愈合，8%（4%的溃疡）患者接受了大截肢手术。共进行了21例大截肢手术，其中18例是由于缺血。因此，仅3例（1%的患者）因神经性溃疡合并侵袭性感染导致大截肢。59处溃疡（12%）被归类为复发性溃疡或有新发病灶的溃疡，主要由足部严重畸形（58例）引起，常伴有预防措施的忽视（7例）。仅1例复发性溃疡由缺血引起。该系列研究表明，鞋具矫正和鞋垫对治疗糖尿病神经性溃疡有效。复发性溃疡由严重足部畸形和治疗忽视引起。肢体缺失由缺血和侵袭性感染导致。
