Bonanno Daniel R, Gillies Elise J
Lecturer, Discipline of Podiatry, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.
Podiatrist, Podiatry Department, Northern Health, Victoria, Australia.
J Foot Ankle Surg. 2017 May-Jun;56(3):600-604. doi: 10.1053/j.jfas.2017.02.011.
Toe deformities are common in people with diabetes and are often associated with toe ulcers. Operative procedures have been used to reduce toe deformities, because these were proposed to be beneficial in the management of toe ulcers. The present systematic review investigated the effect of flexor tenotomy to address toe deformity for healing and preventing diabetes-related toe ulcers. Four electronic databases were searched in January 2016. Studies were included if they had reported the effects of flexor tenotomy for healing and/or preventing diabetes-related toe ulcers. Six studies with a total of 264 flexor tenotomies performed on toes with ulcers and 57 performed as a prophylactic procedure were included. The mean duration of preoperative ulceration was 207.9 (range 7 to 1825) days. The mean duration to postoperative ulcer healing was 29.5 days, with an overall healing rate of 97%. The rate of ulcer recurrence was 6%. All the toes that had undergone prophylactic flexor tenotomy remained free of ulceration. Overall, the rate of complications was low. Flexor tenotomy to address toe deformity is relatively safe and effective in healing and preventing diabetes-related toe ulcers. Flexor tenotomy should be considered in the management of diabetes-related toe ulcers in the presence of toe deformities.
趾畸形在糖尿病患者中很常见，且常与趾溃疡相关。手术操作已被用于减轻趾畸形，因为有人认为这对趾溃疡的治疗有益。本系统评价研究了屈肌腱切断术矫正趾畸形对愈合及预防糖尿病相关趾溃疡的效果。2016年1月检索了四个电子数据库。纳入的研究需报告屈肌腱切断术对愈合和/或预防糖尿病相关趾溃疡的效果。共纳入6项研究，其中对有溃疡的趾进行了264例屈肌腱切断术，57例作为预防性手术。术前溃疡的平均持续时间为207.9（范围7至1825）天。术后溃疡愈合的平均时间为29.5天，总体愈合率为97%。溃疡复发率为6%。所有接受预防性屈肌腱切断术的趾均未发生溃疡。总体而言，并发症发生率较低。屈肌腱切断术矫正趾畸形在愈合和预防糖尿病相关趾溃疡方面相对安全有效。对于存在趾畸形的糖尿病相关趾溃疡患者，应考虑采用屈肌腱切断术。
