Gutman M, Kaplan O, Skornick Y, Klausner J M, Lelcuk S, Rozin R R
Am J Surg. 1987 Sep;154(3):305-8. doi: 10.1016/0002-9610(89)90617-x.
Diabetic foot lesions are a common medical problem with major socioeconomic impact. Gangrene is usually a late and sometimes fatal complication. A series of 118 diabetic patients who underwent amputation of the lower limb at our institution over a 10 year period has been presented. Forty-two patients underwent amputation of the toes or part of the foot, 48 underwent below-knee amputation, and 18 underwent above-knee amputation. In 24 (20.3 percent), the necrotic process advanced postoperatively and necessitated additional amputation. The average hospital stay was 33.6 days. Twenty-eight patients (23.7 percent) died during the postoperative period, and the main cause of death was sepsis. Patients who presented with extensive gangrene had a higher mortality rate. There was no correlation between mortality and the duration of conservative treatment, number of repeated operations, the treatment of diabetes before hospitalization, onset of symptoms, or status of the peripheral pulses. The solution to the problem is early and vigorous preventive treatment. This could be accomplished through highly specialized clinics within the community.
糖尿病足病变是一个常见的医学问题，具有重大的社会经济影响。坏疽通常是一种晚期且有时致命的并发症。本文呈现了在我们机构10年间接受下肢截肢的118例糖尿病患者。42例患者接受了脚趾或部分足部截肢，48例接受了膝下截肢，18例接受了膝上截肢。24例（20.3%）患者术后坏死过程进展，需要再次截肢。平均住院时间为33.6天。28例患者（23.7%）在术后期间死亡，主要死亡原因是败血症。出现广泛坏疽的患者死亡率较高。死亡率与保守治疗持续时间、重复手术次数、住院前糖尿病治疗情况、症状发作或外周脉搏状态之间无相关性。解决该问题的方法是早期积极的预防性治疗。这可以通过社区内高度专业化的诊所来实现。
