Infectious Diseases Department, Bethune Hospital, Bethune, France.
Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France.
Diabetes Metab Res Rev. 2022 Jul;38(5):e3534. doi: 10.1002/dmrr.3534. Epub 2022 May 8.
Conservative surgery (CS) for diabetic foot osteomyelitis (DFO) consists in removing all or part of the infected bone tissues without amputation, in complement with antibiotic therapy. Data on CS for DFO therapy are scarce.
We performed a retrospective analysis of all DFO episodes treated with CS between 06/2007 and 12/2017. Remission was defined by the absence of soft-tissue infection, complete sustained (i.e. > 1 month) healing of the foot ulcer, favourable (i.e., stabilisation or improvement) radiological outcome, and no need for additional surgery during a 1-year follow-up.
During the study period, 47 episodes (in 41 patients) were analysed. Excluding deaths (all unrelated to the DFO; n = 3) or loss to follow-up before 1 year (n = 5), the remission rate was 64.2%. Most failures occurred during the first 6 months (79%, 11/14). Patients who experienced failure had a higher rate of peripheral arterial disease with arterial stenosis than patients in remission (57% vs. 24%, P = 0.03), a higher C-reactive protein rate at admission (116 ± 112 mg/L vs. 48 ± 46 mg/L, P = 0.02), and a trend for a higher rate of abscesses (29% vs. 4%, P = 0.06). At 1-year follow-up, foot ulcers related to transfer lesion were identified in 25.5% of the cases. At the last follow-up (mean 3 ± 2 years), the remission rate was 23/25 (92%).
Our results suggest that CS is a therapeutic option in patients with localised but severe DFO. Clinicians should, however, consider the necessity of revascularisation, and higher risk of failure if surgery is performed in patients presenting with acute foot infections.
糖尿病足骨髓炎（DFO）的保守手术（CS）包括在不截肢的情况下切除全部或部分感染的骨组织，并辅以抗生素治疗。关于 DF0 治疗的 CS 数据很少。
我们对 2007 年 6 月至 2017 年 12 月期间接受 CS 治疗的所有 DFO 患者进行了回顾性分析。缓解定义为软组织感染消失，足部溃疡完全持续（即>1 个月）愈合，影像学结果良好（即稳定或改善），并且在 1 年随访期间无需进一步手术。
在研究期间，分析了 47 例（41 例患者）。排除与 DFO 无关的死亡（n=3）或 1 年随访前失访（n=5）后，缓解率为 64.2%。大多数失败发生在最初的 6 个月内（79%，11/14）。失败患者的外周动脉疾病伴动脉狭窄发生率高于缓解患者（57%对 24%，P=0.03），入院时 C 反应蛋白水平更高（116±112mg/L 对 48±46mg/L，P=0.02），脓肿发生率也有升高趋势（29%对 4%，P=0.06）。在 1 年随访时，发现 25.5%的病例足部溃疡与转移病变有关。在最后一次随访（平均 3±2 年）时，缓解率为 23/25（92%）。
我们的结果表明，CS 是局部但严重 DFO 患者的一种治疗选择。然而，如果在急性足部感染患者中进行手术，临床医生应考虑血管重建的必要性以及更高的失败风险。
