门克贝格氏中膜钙化性硬化症使传统动脉多普勒检查在糖尿病高危患者中不可靠。

Mönckeberg's Medial Calcific Sclerosis Makes Traditional Arterial Doppler's Unreliable in High-Risk Patients with Diabetes.

作者信息

Suludere Mehmet A, Danesh Sahab K, Killeen Amanda L, Crisologo Peter A, Malone Matthew, Siah Michael C, Lavery Lawrence A

机构信息

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Liverpool, New South Wales, Australia.

出版信息

Int J Low Extrem Wounds. 2023 Jul 31:15347346231191588. doi: 10.1177/15347346231191588.

DOI:10.1177/15347346231191588

PMID:37525549

Abstract

OBJECTIVE

To assess Mönckeberg's medial calcific sclerosis (MMCS) severity in patients with a diabetic foot infection.

METHODS

This was an analysis of 2 randomized clinical trials in which we evaluated the treatment of 233 patients admitted to the hospital for moderate and severe foot infections. Arterial calcification was defined as visible radiopaque arteries on foot and ankle radiographs, recorded as the most distal visible artery involved (toes, metatarsals, and ankle/hindfoot).

RESULTS

Most subjects (57.1%, = 133) had MMCS, with extension to toes in 79 (59.4%), to metatarsals in 32 (24.1%), and to ankle/hindfoot in 22 patients (16.5%). In 7 patients (5.2%) MMCS was solely seen in dorsalis pedis (DP) artery, in 13 patients (9.8%) in posterior tibialis (PT) artery, and in 113 patients (85.0%) MMCS was seen in both arteries. Only 29.2% ( = 68) of DP arteries and 34.8% (n = 81) of PT arteries were not compressible by Doppler. DP and PT arteries were not compressible more often in MMCS (DP 34.3% vs 20.4%, = .02 and PT 43.1% vs 21.4%, < .01), toe-brachial indices of ≥0.7 were significantly more common in people without MMCS (46.0% vs 67.4%, < .01). In contrast, there were no differences in skin perfusion pressure measurements (>50 mmHg; 67.7% vs 68.0%, = .96), waveforms (biphasic/triphasic 83.5% vs 77.0%, = .22), and pulse volume recording (9.6 ± 3.3 vs 13.7 ± 36.0) between patients with and without MMCS.

CONCLUSION

MMCS is common in patients with diabetic foot infections. MMCS is associated with noncompressible arterial Doppler studies and likely interferes with the accuracy of arterial Doppler studies.

摘要

目的

评估糖尿病足感染患者的蒙克贝格内侧钙化性硬化症（MMCS）严重程度。

方法

这是一项对2项随机临床试验的分析，我们评估了233例因中度和重度足部感染入院患者的治疗情况。动脉钙化定义为足部和踝关节X线片上可见的不透X线动脉，记录为受累的最远端可见动脉（脚趾、跖骨和踝/后足）。

结果

大多数受试者（57.1%，n = 133）患有MMCS，其中79例（59.4%）延伸至脚趾，32例（24.1%）延伸至跖骨，22例（16.5%）延伸至踝/后足。7例（5.2%）患者仅在足背动脉（DP）发现MMCS，13例（9.8%）患者仅在胫后动脉（PT）发现MMCS，113例（85.0%）患者在两条动脉均发现MMCS。只有29.2%（n = 68）的DP动脉和34.8%（n = 81）的PT动脉不能被多普勒超声压缩。MMCS患者中DP和PT动脉不能被压缩的情况更常见（DP为34.3%对20.4%，P = 0.02；PT为43.1%对21.4%，P < 0.01），踝臂指数≥0.7在无MMCS的人群中显著更常见（46.0%对67.4%，P < 0.01）。相比之下，有或无MMCS的患者在皮肤灌注压测量（>50 mmHg；67.7%对68.0%，P = 0.96）、波形（双相/三相83.5%对77.0%，P = 0.22）和脉搏容积记录（9.6±3.3对13.7±36.0）方面没有差异。