Whisstock Christine, Volpe Antonio, Ninkovic Sasa, Marin Mariagrazia, Meloni Marco, Bruseghin Marino, Boschetti Giovanni, Brocco Enrico
Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, 35031 Abano Terme, PD, Italy.
Department of Orthopedic Surgery, Foot and Ankle Clinic, Abano Terme Polyclinic, 35031 Abano Terme, PD, Italy.
J Clin Med. 2020 Nov 6;9(11):3586. doi: 10.3390/jcm9113586.
Diabetic patients are at increased risk of developing foot ulcers which may cause bone infections associated with a high probability of both amputation and mortality. Therefore, prompt diagnosis and adequate treatment are of key importance. In our Diabetic Foot Unit, effective multidisciplinary treatment of osteomyelitis secondary to diabetes involves the application of a gentamicin-eluting calcium sulphate/hydroxyapatite bone graft substitute to fill residual bone voids after debridement. The data of all patients treated with the gentamicin-eluting calcium sulphate/hydroxyapatite bone graft substitute for diabetic foot infections with ulcer formation and osteomyelitis at metatarsals, calcaneus and hindfoot at our institute from July 2013 to September 2016 were retrospectively collected and evaluated. A total of 35 patients were included in this retrospective single-arm case series and were either continuously followed up for at least one year or until healing was confirmed. Nineteen lesions affected the distal row of tarsus/talus, ten the calcaneus and a further six were located at the metatarsals. While all of the metatarsal lesions had healed at 1-year follow-up, the healing rate in the hindfoot region was lower with 62.5% at the calcaneus and 72.2% at the distal tarsus and talus at 12 months, respectively. The overall cure rate for ulcerous bone infection was 81.3%. In two calcaneal lesions (25%) and two lesions of distal tarsus/talus (11.1%) amputation was considered clinically necessary. Promising results were achieved in the treatment of diabetic foot infections with soft tissue ulcers by a multidisciplinary approach involving extensive debridement followed by adequate dead space management with a resorbable gentamicin-eluting bone graft substitute.
糖尿病患者发生足部溃疡的风险增加，足部溃疡可能导致骨感染，进而导致截肢和死亡的可能性很高。因此，及时诊断和充分治疗至关重要。在我们的糖尿病足病科，对糖尿病继发的骨髓炎进行有效的多学科治疗，包括应用庆大霉素洗脱硫酸钙/羟基磷灰石骨移植替代物，以填充清创术后残留的骨缺损。回顾性收集并评估了2013年7月至2016年9月在我院接受庆大霉素洗脱硫酸钙/羟基磷灰石骨移植替代物治疗糖尿病足感染伴溃疡形成及跖骨、跟骨和后足骨髓炎的所有患者的数据。本回顾性单臂病例系列共纳入35例患者，这些患者均接受了至少一年的持续随访或直至确认愈合。19处病变累及跗骨远端/距骨，10处累及跟骨，另外6处位于跖骨。虽然所有跖骨病变在1年随访时均已愈合，但后足区域的愈合率较低，跟骨在12个月时的愈合率为62.5%，跗骨远端和距骨为72.2%。溃疡骨感染的总体治愈率为81.3%。在2处跟骨病变（25%）和2处跗骨远端/距骨病变（11.1%）中，临床上认为有必要进行截肢。通过多学科方法治疗糖尿病足感染伴软组织溃疡取得了良好效果，该方法包括广泛清创，随后使用可吸收的庆大霉素洗脱骨移植替代物进行充分的死腔管理。
