Wennberg Linda, Lundgren Paul, Axelsson Rimma, Aspelin Peter, Gerok-Andersson Kurt, Åkerlund Börje
Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.
Department of Orthopedics, Södertälje Hospital, Sweden.
J Clin Transl Endocrinol. 2017 Jun 29;9:32-37. doi: 10.1016/j.jcte.2017.06.001. eCollection 2017 Sep.
Osteoarthropathy, a rare foot complication in patients with diabetes mellitus, calls for immediate and optimal management to prevent irreversible bone/joint destruction and risk of amputation. Awareness of the condition and adequate guidelines would minimize the consequences and the costs, both for the patient and for the society. We investigated the diabetic osteoarthropathy care in Swedish orthopedic clinics.
A questionnaire was distributed to 63 Swedish hospitals with emergency department for orthopedic patients. There was a 95% response rate.
Most of the respondents (79%) specified absence of established procedures including guidelines for managing patients with osteoarthropathy. The most common diagnostic method was clinical diagnosis and plain X-ray (95%). MRI or scintigraphy was used by 19% and 10.5% respectively. As treatment method, 84% used a total contact cast, while 38% used orthoses. Treatment duration <3 months was reported in 4%, 3-6 months in 53% and 6-12 months in 28% of the clinics. Four clinics reported treatment duration >12 months and two clinics provided no treatment.
Our national inventory indicates a need for improvement in knowledge as well as guidance and organization at orthopedic clinics regarding optimal care of patients with diabetic osteoarthropathy.
骨关节炎是糖尿病患者罕见的足部并发症，需要立即进行最佳治疗，以防止不可逆转的骨/关节破坏和截肢风险。提高对该病症的认识并制定适当的指导方针，将能最大限度地降低对患者和社会造成的后果及成本。我们对瑞典骨科诊所的糖尿病性骨关节炎护理情况进行了调查。
向63家设有骨科急诊的瑞典医院发放了问卷。回复率为95%。
大多数受访者（79%）表示没有既定的程序，包括骨关节炎患者管理指南。最常见的诊断方法是临床诊断和普通X光检查（95%）。分别有19%和10.5%的受访者使用了磁共振成像（MRI）或骨闪烁显像。作为治疗方法，84%的诊所使用全接触石膏，38%的诊所使用矫形器。4%的诊所报告治疗时间<3个月，53%的诊所报告治疗时间为3 - 6个月，28%的诊所报告治疗时间为6 - 12个月。有4家诊所报告治疗时间>12个月，2家诊所未提供治疗。
我们的全国性调查表明，骨科诊所在糖尿病性骨关节炎患者的最佳护理方面，在知识、指导和组织方面都需要改进。
