Bobirca Florin, Smarandache Catalin Gabriel, Bobirca Anca, Alexandru Cristina, Dumitrescu Dan, Stoian Anca Pantea, Bica Cristina, Brinduse Lacramioara Aurelia, Musetescu Anca, Gheoca-Mutu Daniela-Elena, Isac Sebastian, Ancuta Ioan
Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Surgery Department, Dr. Ion Cantacuzino Clinical Hospital, 011437 Bucharest, Romania.
Life (Basel). 2022 Jul 29;12(8):1156. doi: 10.3390/life12081156.
The prevalence of diabetic foot complications is continuously increasing as diabetes has become one of the most important "epidemics" of our time. The main objective of this study was to describe the appropriate surgical intervention for the complicated neuropathic diabetic foot; the secondary goal was to find the risk factors associated with minor/major amputation and good or adverse surgical outcomes. This is an observational, retrospective study conducted between 1 January 2018 and 31 December 2019, which included 251 patients from the General Surgery Department at the Dr I. Cantacuzino Clinical Hospital in Bucharest with type II diabetes mellitus and neuropathic diabetic foot complications. The surgical conditions identified at admission were the following: osteitis (38.6%), infected foot ulcer (27.5%), gangrene (20.7%), infected Charcot foot (3.6%), non-healing wound (3.6%), necrosis (3.2%), and granulated wound (2.8%). We found that a minor surgical procedure (transmetatarsal amputation of the toe and debridement) was performed in 85.8% of cases, and only 14.2% needed major amputations. Osteitis was mainly associated with minor surgery ( = 0.001), while the gangrene and the infected Charcot foot were predictable for major amputation, with OR = 2.230, 95% CI (1.024-4.857) and OR = 5.316, 95% CI (1.354-20.877), respectively. Admission anemia and diabetic nephropathy were predictive of a major therapeutical approach, with = 0.011, OR = 2.975, 95% CI (1.244-8.116) and = 0.001, OR = 3.565, 95% CI (1.623-7.832), respectively. All the major amputations had a good outcome, while only several minor surgeries were interpreted as the adverse outcome ( = 24). Osteitis (45.8%) and admission anemia (79.2%) were more frequently associated with adverse outcomes, with = 0.447 and = 0.054, respectively. The complicated neuropathic diabetic foot requires a surgical procedure mainly associated with a good outcome.
随着糖尿病已成为我们这个时代最重要的“流行病”之一，糖尿病足并发症的患病率在持续上升。本研究的主要目的是描述针对复杂神经性糖尿病足的适当手术干预措施；次要目标是找出与小/大截肢以及良好或不良手术结果相关的风险因素。这是一项于2018年1月1日至2019年12月31日期间进行的观察性回顾性研究，纳入了布加勒斯特I. Cantacuzino临床医院普通外科的251例患有II型糖尿病和神经性糖尿病足并发症的患者。入院时确定的手术情况如下：骨炎（38.6%）、足部感染性溃疡（27.5%）、坏疽（20.7%）、感染性夏科氏足（3.6%）、伤口不愈合（3.6%）、坏死（3.2%）和肉芽创面（2.8%）。我们发现，85.8%的病例进行了小手术（趾骨间截肢和清创术），只有14.2%的病例需要进行大截肢。骨炎主要与小手术相关（P = 0.001），而坏疽和感染性夏科氏足则可预测大截肢，其比值比分别为2.230，95%置信区间（1.024 - 4.857）和5.316，95%置信区间（1.354 - 20.877）。入院时贫血和糖尿病肾病可预测需要采取主要治疗方法，P值分别为0.011，比值比为2.975，95%置信区间（1.244 - 8.116）和P = 0.001，比值比为3.565，95%置信区间（1.623 - 7.832）。所有大截肢手术都取得了良好的结果，而只有几例小手术被判定为不良结果（n = 24）。骨炎（45.8%）和入院时贫血（79.2%）与不良结果的关联更为频繁，P值分别为0.447和0.054。复杂神经性糖尿病足需要进行的手术主要与良好的结果相关。
