Belgaid V, Courtin C, Desmarchelier R, Fessy M, Besse J L
Department of Orthopaedic and Traumatology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France.
Malays Orthop J. 2020 Nov;14(3):82-89. doi: 10.5704/MOJ.2011.013.
Diabetic foot ulcer is the main aetiology for non-traumatic amputation, which is a major public health care concern. A multidisciplinary approach in the management of this pathology has been shown to improve the surgical outcome. However, there are little data available on the tools we can use to pursue this multidisciplinary approach. The main goal of this cross-sectional study was to find out whether the implementation of a specific management pathway could improve the treatment outcome in the treatment of diabetic foot.
From 2012 to 2014, we consecutively recruited patients with diabetic foot referred to Orthopaedic surgery department of our university for surgical opinion. A specific diabetic foot pathway was introduced in 2013. One group of patients who were treated with previous method were evaluated retrospectively. Another group of patients who were treated after implementation of the pathway were evaluated prospectively. We compared treatment outcome between the two groups.
We included 51 patients. Amputation rate was similar both the groups: 74% in the retrospective group not using the new pathway versus 73% in a prospective group that used the new pathway. Revision surgery was 39% in the retrospective group and 14% in the prospective group (p=0.05).
We recommend the use of this simple and cost-effective pathway to guide the interdisciplinary management of diabetic foot. A prospective study with more subjects would provide a better overview of this management pathway.
糖尿病足溃疡是非创伤性截肢的主要病因，这是一个重大的公共卫生问题。已证明采用多学科方法管理这种病症可改善手术效果。然而，关于我们可用于采用这种多学科方法的工具的数据很少。这项横断面研究的主要目的是确定实施特定的管理途径是否能改善糖尿病足的治疗效果。
2012年至2014年，我们连续招募了因手术意见转诊至我校骨科的糖尿病足患者。2013年引入了特定的糖尿病足治疗途径。一组采用先前方法治疗的患者进行回顾性评估。另一组在实施该途径后治疗的患者进行前瞻性评估。我们比较了两组的治疗效果。
我们纳入了51名患者。两组的截肢率相似：未使用新途径的回顾性组为74%，使用新途径的前瞻性组为73%。回顾性组的翻修手术率为39%，前瞻性组为14%（p = 0.05）。
我们建议使用这种简单且具有成本效益的途径来指导糖尿病足的跨学科管理。一项纳入更多受试者的前瞻性研究将能更好地概述这种管理途径。
