Unité de Podologie Service de Diabétologie Pr Agnes Hartemann, Hôpital Pitié Salpêtrière, 47-83 Boulevard de l'Hôpital 75013, Paris, France.
J Wound Care. 2020 Aug 2;29(8):464-471. doi: 10.12968/jowc.2020.29.8.464.
To describe the rates of healing, major amputation and mortality after 12 months in patients with a new diabetic foot ulcer (DFU) and their care in a French diabetic foot service (DFS).
A prospective single-centre study including patients from March 2009 to December 2010. The length of time to healing, minor amputation, major amputation and mortality rate after inclusion were analysed using the Kaplan-Meier method.
Some 347 patients were included (3% lost to follow-up), with a median follow-up (IQR) of 19 (12-24) months. The mean (SD) age was 65±12 years, 68% were male, and the median duration of the ulcer was 49 (19-120) days. Complications of the DFU were ischaemia (70%), infection (55%) and osteomyelitis (47%). Of the patients, 50% were inpatients in the DFS at inclusion (median duration of hospitalisation 26 (15-41) days). The rate of healing at one year was 67% (95% confidence interval (CI): 61-72); of major amputation 10% (95% CI: 7-17); of minor amputation 19% (95% CI: 14-25), and the death rate was 9% (95% CI: 7-13). Using an adjusted hazard ratio, the predictive factors of healing were perfusion and the area of the wound. The risk factors for a major amputation were active smoking and osteomyelitis. The risk factors for mortality were perfusion and age.
This study confirms the need to treat DFUs rapidly, in a multidisciplinary DFS.
描述法国糖尿病足服务（DFS）中新发糖尿病足溃疡（DFU）患者在 12 个月时的愈合率、大截肢和死亡率，以及他们的护理情况。
这是一项前瞻性单中心研究，纳入了 2009 年 3 月至 2010 年 12 月的患者。采用 Kaplan-Meier 法分析纳入后的愈合时间、小截肢、大截肢和死亡率。
共纳入 347 例患者（3%失访），中位随访（IQR）时间为 19（12-24）个月。患者的平均（SD）年龄为 65±12 岁，68%为男性，溃疡的中位病程为 49（19-120）天。DFU 的并发症为缺血（70%）、感染（55%）和骨髓炎（47%）。纳入时，50%的患者在 DFS 住院（住院时间中位数为 26（15-41）天）。一年的愈合率为 67%（95%置信区间（CI）：61-72）；大截肢率为 10%（95% CI：7-17）；小截肢率为 19%（95% CI：14-25），死亡率为 9%（95% CI：7-13）。采用调整后的风险比，愈合的预测因素是灌注和伤口面积。大截肢的危险因素是主动吸烟和骨髓炎。死亡的危险因素是灌注和年龄。
这项研究证实了需要在多学科 DFS 中迅速治疗 DFU。
