Harrelson J M
Musculoskeletal Oncology Division, Duke University Medical Center, Durham, North Carolina.
Orthop Clin North Am. 1989 Oct;20(4):605-19.
Treatment of diabetic foot pathology requires an accurate assessment of the etiologic factors involved. Dysvascular deterioration may be amenable to vascular reconstruction. When the vascular status cannot be improved, however, amputation is preferable to continued conservative care. Neuropathic ulceration is the product of decreased sensation, deformity, and increased pressure at the site of the ulcer. Pressure relief by conservative or surgical means is required for healing. Neuroarthropathy is increasing in frequency and results primarily from autonomic denervation. Protection from weight bearing and orthotic control usually minimize deformity and ultimately restore the patient to an ambulatory status. Surgical intervention in neuroarthropathy may be effective when conservative means fail. All efforts at treatment may be undermined by poor compliance. Patient education, reinforced at each clinic visit, makes the patient a part of the treatment team.
糖尿病足病变的治疗需要准确评估相关的病因。血管功能恶化可能适合进行血管重建。然而，当血管状况无法改善时，截肢比继续进行保守治疗更为可取。神经性溃疡是感觉减退、畸形以及溃疡部位压力增加的结果。愈合需要通过保守或手术手段减轻压力。神经关节病的发病率正在上升，主要是由自主神经去神经支配引起的。避免负重和使用矫形器通常可以将畸形降至最低，并最终使患者恢复行走状态。当保守治疗无效时，对神经关节病进行手术干预可能有效。治疗过程中的所有努力都可能因依从性差而受到影响。在每次门诊就诊时加强患者教育，使患者成为治疗团队的一员。
