屈肌腱切断术以降低糖尿病神经病变性足趾溃疡复发风险后的生物力学和肌肉骨骼变化。
Biomechanical and musculoskeletal changes after flexor tenotomy to reduce the risk of diabetic neuropathic toe ulcer recurrence.
机构信息
Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Amsterdam UMC, Department of Rehabilitation Medicine, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
出版信息
Diabet Med. 2022 Apr;39(4):e14761. doi: 10.1111/dme.14761. Epub 2021 Dec 16.
OBJECTIVE
To assess the effect of flexor tenotomy in patients with diabetes on barefoot plantar pressure, toe joint angles and ulcer recurrence during patient follow-up.
METHODS
Patients with a history of ulceration on the toe apex were included. They underwent minimally invasive needle flexor tenotomy by an experienced musculoskeletal surgeon. Dynamic barefoot plantar pressure measurements and static weight-bearing radiographs were taken before and 2-4 weeks after the procedure.
RESULTS
A total of 14 patients underwent flexor tenotomy on 50 toes in 19 feet. There was a mean follow-up time of 11.4 months. No ulcer recurrence occurred during follow-up. Mean barefoot plantar pressure was assessed on 34 toes and decreased significantly after the procedure by a mean 279 kPa (95% CI: 204-353; p < 0.001). Metatarsophalangeal, proximal interphalangeal and distal interphalangeal joint angles were assessed on nine toes and all decreased significantly (by 7° [95% CI: 4-9; p < 0.001], 19° [95% CI: 11-26; p < 0.001] and 28° [95% CI: 13-44; p = 0.003], respectively).
CONCLUSION
These observations show a beneficial effect of flexor tenotomy on biomechanical and musculoskeletal outcomes in the toes, without ulcer recurrence.
目的
评估糖尿病患者屈肌腱切断术对足底压力、趾关节角度和溃疡复发的影响。
方法
纳入有趾尖溃疡史的患者。由经验丰富的运动医学外科医生进行微创针式屈肌腱切断术。在手术前和术后 2-4 周，进行动态足底压力测量和静态负重 X 线检查。
结果
共有 14 名患者的 50 个脚趾接受了屈肌腱切断术，涉及 19 只脚。平均随访时间为 11.4 个月。随访期间无溃疡复发。在 34 个脚趾上评估了平均足底压力，术后平均降低了 279kPa（95%CI：204-353；p<0.001）。在 9 个脚趾上评估了跖趾、近节和远节趾间关节角度，所有角度均显著降低（分别为 7°[95%CI：4-9；p<0.001]、19°[95%CI：11-26；p<0.001]和 28°[95%CI：13-44；p=0.003]）。
结论
这些观察结果表明，屈肌腱切断术对趾部生物力学和肌肉骨骼结果有有益影响，且无溃疡复发。
Zotero 插件