Molines-Barroso Raúl Juan, García-Álvarez Yolanda, García-Klepzig José Luis, García-Morales Esther, Álvaro-Afonso Francisco Javier, Lázaro-Martínez José Luis
Diabetic Foot Unit, Medical Faculty, Complutense University of Madrid, IdISSC, 28040 Madrid, Spain.
Internal Medicine Department, San Carlos Clinic Hospital, IdISSC, 28040 Madrid, Spain.
J Clin Med. 2020 Mar 14;9(3):794. doi: 10.3390/jcm9030794.
We aimed to evaluate the differences in the sub-metatarsal skin and fat pad atrophy between patients at a high risk of ulceration with and without previous metatarsal head resection. A cross-sectional study was performed in a diabetic foot unit involving 19 participants with a history of metatarsal head resection (experimental group) and 19 (control group) without a history of metatarsal head resection but with an ulcer in other locations in the metatarsal head. No participants had active ulcerations at study inclusion. Sub-metatarsal skin thickness and fat pad thickness in the first and second metatarsals were evaluated by an ultrasound transducer. The experimental group showed sub-metatarsal fat pad atrophy (3.74 ± 1.18 mm and 2.52 ± 1.04 mm for first and second metatarsal, respectively) compared with the control group (5.44 ± 1.12 mm and 4.73 ± 1.59 mm) ( < 0.001, confidence interval: (CI): 0.943-2.457 and < 0.001, CI: 1.143-3.270 for first and second metatarsal, respectively); however, sub-metatarsal skin thickness was not different between groups (experimental 2.47 ± 0.47 mm vs. control 2.80 ± 0.58 mm ( = 0.063, CI: -0.019-0.672) and 2.24 ± 0.60 mm vs. 2.62 ± 0.50 mm ( = 0.066, CI: -0.027-0.786) for first and second metatarsal, respectively). Patients with previous metatarsal head resection showed sub-metatarsal fat pad atrophy, which could be associated with the risk of reulceration in the metatarsal head.
我们旨在评估既往有跖骨头切除术和无跖骨头切除术的溃疡高危患者之间跖骨头下皮肤和脂肪垫萎缩的差异。在一个糖尿病足治疗单元进行了一项横断面研究，纳入了19名有跖骨头切除术史的参与者（实验组）和19名（对照组）无跖骨头切除术史但在跖骨头其他部位有溃疡的参与者。纳入研究时所有参与者均无活动性溃疡。通过超声换能器评估第一和第二跖骨的跖骨头下皮肤厚度和脂肪垫厚度。与对照组（第一跖骨5.44±1.12mm，第二跖骨4.73±1.59mm）相比，实验组显示跖骨头下脂肪垫萎缩（第一跖骨分别为3.74±1.18mm和第二跖骨2.52±1.04mm）（<0.001，置信区间：（CI）：0.943 - 2.457；第一跖骨和第二跖骨<0.001，CI分别为1.143 - 3.270）；然而，两组之间跖骨头下皮肤厚度无差异（实验组第一跖骨2.47±0.47mm vs.对照组2.80±0.58mm（P = 0.063，CI：-0.019 - 0.672），第二跖骨2.24±0.60mm vs. 2.62±0.50mm（P = 0.066，CI：-0.027 - 0.786））。既往有跖骨头切除术的患者显示跖骨头下脂肪垫萎缩，这可能与跖骨头再次溃疡的风险相关。
