Department of Vascular Surgery, Faculty of Medicine, Tanta University, Tanta, Gharbiah Governorate, Egypt.
Int J Low Extrem Wounds. 2022 Dec;21(4):535-543. doi: 10.1177/1534734620971106. Epub 2020 Nov 23.
Although surgical offloading seems a more permanent solution for prevention and treatment of neuropathic plantar diabetic forefoot ulcers (DFUs), the evidence for this assumption is weak and needs further studies to be established. The aim of this retrospective study is to compare the healing efficacy, associated morbidity, and recurrence rates of surgical versus removable knee-high offloading for neuropathic plantar (DFUs) healing. From January 2016 to January 2018, 70 neuropathic plantar forefoot DFUs were nonrandomly assigned to either removable knee-high cam-walker (n = 35), or metatarsal head, or accessory bone resection (n = 35). The primary endpoints were the frequency and rate of complete healing, and the rate of ulcer area reduction within 4 months. The secondary endpoints were 4 months morbidity and ulcer recurrence within 12 months. After 4 months, complete healing was significantly inferior with cam-walker compared with surgical offloading; 24 (67.6%) versus 31 patients (88.6%), respectively, = .015. Ulcer area reduction was 2.4 cm (66.7%) versus 2.6 cm (83.9%), = .001, in the mechanical versus the surgical groups, respectively. The mean healing time was 3.6 ± 2.1 versus 2.8 ± 0.6 months in the mechanical versus the surgical groups, respectively, = .012. Morbidity and recurrence show nonsignificant differences between both groups. Ulcer recurrence was noted in 5/35 (14.3%) versus 2/35 (5.7%), in mechanical versus surgical groups, respectively, = .23. Therefore, metatarsal head/accessory bone resection offered improved healing efficacy but similar morbidity and recurrence to the removable cam-walker.
虽然手术减压似乎是预防和治疗糖尿病性神经病变足底前足溃疡（DFU）的更持久解决方案，但这一假设的证据很薄弱，需要进一步的研究来证实。本回顾性研究的目的是比较手术与可移动膝高式减压治疗糖尿病性神经病变足底（DFU）愈合的愈合效果、相关发病率和复发率。2016 年 1 月至 2018 年 1 月，70 例糖尿病性神经病变足底前足 DFU 患者被非随机分为可移动膝高式 cam-walker（n = 35）或跖骨头或副骨切除术（n = 35）。主要终点是完全愈合的频率和速度，以及 4 个月内溃疡面积缩小的速度。次要终点是 4 个月时的发病率和 12 个月内的溃疡复发率。4 个月后，cam-walker 组的完全愈合率明显低于手术减压组，分别为 24（67.6%）和 31 例（88.6%），=.015。机械组和手术组的溃疡面积缩小率分别为 2.4 cm（66.7%）和 2.6 cm（83.9%），=.001。机械组和手术组的平均愈合时间分别为 3.6 ± 2.1 个月和 2.8 ± 0.6 个月，=.012。两组的发病率和复发率无显著差异。机械组和手术组溃疡复发分别为 5/35（14.3%）和 2/35（5.7%），=.23。因此，跖骨头/副骨切除术的愈合效果优于可移动的 cam-walker，但发病率和复发率相似。
