Giurato Laura, Andrea Panunzi, Meloni Marco, Pecchioli Chiara, D'Ambrogi Emanuela, Uccioli Luigi
Endocrinology and Diabetology Unit, CTO/SE Hospitals, Rome, Italy.
Department of Biomedicine, Prevention University of Rome Tor Vergata, Rome, Italy.
Int J Low Extrem Wounds. 2023 Aug 31:15347346231191583. doi: 10.1177/15347346231191583.
The aim of our study was to identify risk factors for the recurrence of diabetic foot ulcers (DFUs) in a selected population of patients in secondary prevention treated, according to International Guidelines, with an integrated foot care protocol by a referral diabetic foot clinic. A retrospective study was performed with the inclusion of selected outpatients with diabetes at higher risk for ulceration with a history of previous ulcer and/or amputation followed in our diabetic foot clinic between January 2015 and December 2021. According to the presence or absence of recurrence, patients were divided into 2 groups: ulcer recurrence and without ulcer recurrence. One hundred twenty-seven (127) patients were included, 47 patients (37%) developed an ulcer recurrence while 80 patients (63%) did not. The mean age was 71.7 years; 65% were male; 97% were affected by type 2 diabetes with a mean duration of 21.1 years, the mean HbA1c was 63 + 21 mmol/mol. Both groups of patients had foot deformities, such as claw and hammertoes; hallux valgus, and prominent metatarsal heads (MTHs). The presence of deformity was significantly associated with ulceration. The group with ulcer recurrence showed a higher rate of prominence MTHs in comparison to a group without ulcer recurrence. The MTHs resulted as the only independent predictor for recurrence. This study shows that the presence of the prominent MTH is a significant risk factor for ulcer recurrence in a selected population of diabetic foot patients treated in the best way with integrated foot care.
我们研究的目的是在一组接受二级预防的特定患者群体中，确定糖尿病足溃疡（DFU）复发的风险因素。这些患者按照国际指南，由一家转诊糖尿病足诊所采用综合足部护理方案进行治疗。我们进行了一项回顾性研究，纳入了2015年1月至2021年12月期间在我们糖尿病足诊所随访的、有溃疡和/或截肢史且溃疡风险较高的特定糖尿病门诊患者。根据是否复发，患者被分为两组：溃疡复发组和无溃疡复发组。共纳入127例患者，其中47例（37%）出现溃疡复发，80例（63%）未复发。平均年龄为71.7岁；65%为男性；97%患2型糖尿病，平均病程21.1年，平均糖化血红蛋白为63 + 21 mmol/mol。两组患者均有足部畸形，如爪形趾和槌状趾；拇外翻以及突出的跖骨头（MTH）。畸形的存在与溃疡显著相关。与无溃疡复发组相比，溃疡复发组的MTH突出率更高。MTH是复发的唯一独立预测因素。本研究表明，对于接受最佳综合足部护理治疗的特定糖尿病足患者群体，突出的MTH是溃疡复发的一个重要风险因素。
