Biz Carlo, Gastaldo Stefano, Dalmau-Pastor Miki, Corradin Marco, Volpin Andrea, Ruggieri Pietro
1 Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy.
2 Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, Barcelona, Spain.
Foot Ankle Int. 2018 Jan;39(1):83-92. doi: 10.1177/1071100717735640. Epub 2017 Nov 7.
The aims of this prospective study were first to evaluate the safety and effectiveness of minimally invasive distal metatarsal diaphyseal osteotomies (DMDOs) for treating a consecutive series of diabetic patients with chronic plantar diabetic foot ulcers (CPDFUs) and second to assess their clinical-functional and radiographic outcomes.
A consecutive series of patients affected by diabetes mellitus with CPDFUs, not responsive to previous nonoperative management, underwent DMDO. The CPDFUs were evaluated using the University of Texas Diabetic Wound Classification System (UTDWC). Demographic parameters, Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS) scores, healing times, and complications were recorded. Maestro et al criteria and bone callus formation were analyzed radiologically. Statistical analysis was carried out ( P < .05). Thirty consecutive enrolled patients with a mean age of 66.7 (range, 53-75) years presented 35 CPDFUs with a mean diameter of 16.3 mm and a mean duration of 10.3 months. The most frequent grade of the UTDWC was IIIB (42.9%).
All ulcers recovered with a mean healing time of 7.9 ± 4.0 (range, 4-17) weeks. AOFAS scores improved significantly from 55.3 to 81.4 points ( P < .001). At a mean follow-up of 25.3 months (range, 18-71), no cases of ulcer recurrence were recorded, while a major complication or a wound infection required longer healing time.
Minimally invasive DMDO was a safe and effective method in promoting CPDFU healing, regardless of the grade of severity, by the reduction of the high plantar pressure under the metatarsal heads. This technique improved functional and radiographic outcomes with few complications.
IV, case series.
本前瞻性研究的目的，一是评估微创跖骨干远端截骨术（DMDO）治疗一系列连续性慢性糖尿病足底溃疡（CPDFU）糖尿病患者的安全性和有效性；二是评估其临床功能和影像学结果。
对一系列连续性患有CPDFU且对先前非手术治疗无反应的糖尿病患者进行DMDO。使用德克萨斯大学糖尿病伤口分类系统（UTDWC）对CPDFU进行评估。记录人口统计学参数、足踝协会（AOFAS）评分、视觉模拟量表（VAS）评分、愈合时间和并发症。采用Maestro等人的标准并通过影像学分析骨痂形成情况。进行统计学分析（P < .05）。连续纳入30例患者，平均年龄66.7岁（范围53 - 75岁），共出现35处CPDFU，平均直径16.3 mm，平均病程10.3个月。UTDWC最常见的分级为IIIB级（42.9%）。
所有溃疡均愈合，平均愈合时间为7.9 ± 4.0周（范围4 - 17周）。AOFAS评分从55.3分显著提高至81.4分（P < .001）。平均随访25.3个月（范围18 - 71个月），未记录到溃疡复发病例，而出现的主要并发症或伤口感染需要更长的愈合时间。
微创DMDO是一种安全有效的方法，可通过降低跖骨头下的足底高压促进CPDFU愈合，无论严重程度如何。该技术改善了功能和影像学结果，且并发症较少。
IV，病例系列。
