National Health Commission of the People's Republic of China Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Department of Diabetic Foot, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China.
Department of Dermatology, Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing, China.
Front Endocrinol (Lausanne). 2023 Aug 2;14:1165305. doi: 10.3389/fendo.2023.1165305. eCollection 2023.
Although the pathology and bacterial status of the "normal" bone stump after operation of diabetic foot osteomyelitis (DFO) are of great significance for the prognosis of foot wounds, there are only a few studies on this topic; hence, it is clinically relevant and urgent to study this topic.
The data of 57 inpatients with DFO from June 2021 to April 2022 were collected, all of whom had DFO in the forefoot and underwent conservative surgery. After the surgical removal of necrotic bone, bone biopsies were taken from the necrotic phalangeal bone and the reserved "normal" metatarsal stump. They were cultured, after which antibiotic susceptibility test and pathological screening were carried out. According to clinical judgment, inpatients' wounds were divided into metatarsal affected group and metatarsal unaffected group. We then compared and analyzed the pathological and bacterial characteristics of preserved "normal" bone stump and its effect on wound healing and prognosis.
The poor concordance rate between deep soft tissue culture and infected phalange culture was only 19.3%. The deep soft tissue (72.6%), infected phalange (70.7%), and metatarsal stump (71.4%) were mainly infected with gram-negative Bacillus. The proportion of increased significantly in bone tissue. had the highest drug resistance (88%, 22/25). There was no significant difference in several clinical characteristics and wound healing regardless of whether their metatarsal stumps were affected. Most reserved "normal" metatarsal stumps (84.2%, 48/57) were positive by pathological diagnosis and bacterial culture testing; only 15.7% (9/57) samples were truly sterile. Only 8.3% (4/48) of the former patients healed within 6 months; whereas, all the latter (9/9) patients healed within 6 months. However, the majority (89.6%, 43/48) could heal. There was no difference in operations, skin grafting, negative pressure wound therapy, and mortality between the two groups.
The most reserved "normal" metatarsal stumps have been invaded by bacteria. However, the majority stumps can be preserved, and the wound will eventually be healed according to the pathological and bacterial culture results.
尽管糖尿病足骨髓炎（DFO）术后“正常”骨残端的病理和细菌状况对足部伤口的预后具有重要意义，但针对这一课题的研究较少；因此，研究这一课题具有重要的临床意义和紧迫性。
收集 2021 年 6 月至 2022 年 4 月间 57 例 DFO 住院患者的资料，均为前足 DFO 且行保守手术，在切除坏死骨后，取自发性坏死指骨和保留的“正常”跖骨残端的骨活检标本进行培养，随后进行抗生素敏感性试验和病理筛查。根据临床判断，将住院患者的伤口分为跖骨受累组和跖骨未受累组，然后比较和分析保留的“正常”骨残端的病理和细菌特征及其对伤口愈合和预后的影响。
深部软组织培养与感染指骨培养的一致性较差，仅为 19.3%。深部软组织（72.6%）、感染指骨（70.7%）和跖骨残端（71.4%）主要感染革兰氏阴性杆菌。骨组织中 的比例显著增加。药物耐药性最高的是 （88%，22/25）。无论跖骨残端是否受累，两组患者的几个临床特征和伤口愈合情况均无显著差异。保留的“正常”跖骨残端（84.2%，48/57）的病理诊断和细菌培养检测结果大多为阳性，仅 15.7%（9/57）的样本为真正无菌。前者中仅 8.3%（4/48）的患者在 6 个月内愈合，而后者（9/9）均在 6 个月内愈合。但多数（89.6%，43/48）能够愈合。两组患者的手术、植皮、负压伤口治疗和死亡率均无差异。
保留的“正常”跖骨残端大多已被细菌侵犯，但根据病理和细菌培养结果，多数残端可以保留，伤口最终会愈合。
