Akkurt Mehmet Orçun, Demirkale Ismail, Öznur Ali
Departments of Orthopaedics and Traumatology, Ankara Yenimahalle Education and Research Hospital , Ankara , Turkey.
Keçiören Education and Research Hospital, Department of Orthopaedics , Ankara , Turkey.
Diabet Foot Ankle. 2017 Jan 20;8(1):1264699. doi: 10.1080/2000625X.2017.1264699. eCollection 2017.
: The treatment of diabetic hindfoot ulcers is a challenging problem. In addition to serial surgical debridements, hyperbaric oxygen therapy and local wound care play important roles in the surgeon's armamentarium, for both superficial infection and gangrene of the soft tissue, often complicated by osteomyelitis of the calcaneus. The purpose of this study was to evaluate the results of an aggressive approach from diagnosis to treatment of calcaneal osteomyelitis in foot-threatening diabetic calcaneal ulcers. : The study included 23 patients with diabetic hindfoot ulcers who were treated with radical excision of the necrotic tissue and application of circular external fixation. The treatment protocol was a combination of magnetic resonance imaging (MRI)-guided debridement of the necrotic tissues and application of an Ilizarov external fixator in plantarflexion to decrease the soft-tissue defect. Primary outcome measures were total cure of infection and obvious healing of the osteomyelitis at 12 weeks determined by MRI, and clinical cure through objective assessment of the appearance of the wound. : The wounds healed in 18 of the 23 patients (78%), partial recovery occurred and subsequent flap operation was performed in three patients (13%), and below-the-knee amputation was performed in two patients (9%). : This surgical protocol is effective in ameliorating diabetic hindfoot ulcers with concomitant calcaneal osteomyelitis, and satisfactorily reduces the need for amputation.
糖尿病后足溃疡的治疗是一个具有挑战性的问题。除了系列外科清创术外，高压氧治疗和局部伤口护理在外科医生的治疗手段中对于软组织的浅表感染和坏疽（常并发跟骨骨髓炎）起着重要作用。本研究的目的是评估一种从诊断到治疗威胁足部的糖尿病跟骨溃疡合并跟骨骨髓炎的积极方法的效果。：该研究纳入了23例糖尿病后足溃疡患者，他们接受了坏死组织的根治性切除和环形外固定架的应用。治疗方案是磁共振成像（MRI）引导下坏死组织清创术与应用跖屈位的伊里扎洛夫外固定架以减少软组织缺损相结合。主要结局指标是通过MRI确定12周时感染完全治愈和骨髓炎明显愈合，以及通过对伤口外观的客观评估实现临床治愈。：23例患者中有18例（78%）伤口愈合，3例患者（13%）部分恢复并随后进行了皮瓣手术，2例患者（9%）进行了膝下截肢。：该手术方案对于改善合并跟骨骨髓炎的糖尿病后足溃疡有效，并令人满意地减少了截肢需求。
