Alkhalfan Yousif, Lewis Thomas Lorchan, Kavarthapu Venu, Hester Thomas
Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, UK.
J Clin Orthop Trauma. 2023 Dec 31;48:102330. doi: 10.1016/j.jcot.2023.102330. eCollection 2024 Jan.
Diabetic foot osteomyelitis (DFO) poses a significant challenge in the management of diabetic patients, often leading to severe complications and increased morbidity. Effective management of DFO requires a multidisciplinary approach, involving endocrinologists, infectious disease specialists, vascular surgeons, orthopaedic surgeons, and wound care experts. Early diagnosis is paramount, facilitated by advanced imaging techniques such as magnetic resonance imaging (MRI) and bone scintigraphy. Once diagnosed, the treatment strategy hinges on a combination of medical and surgical interventions. Antibiotic therapy, guided by culture results, plays a central role in managing DFO. Tailored regimens targeting the specific pathogens involved are administered, often for prolonged durations. Surgical intervention becomes necessary when conservative measures fall short. Surgical approaches range from minimally invasive procedures, like percutaneous drainage, to more extensive interventions like debridement and bone resection. Prevention of DFO recurrence is equally vital, emphasising glycemic control, meticulous foot care, patient education, monitoring of at-risk signs, revascularization and early intervention when indicated. The management of diabetic foot osteomyelitis mandates a comprehensive strategy that addresses both the infectious and surgical aspects of the condition. A collaborative, interdisciplinary approach ensures timely diagnosis, tailored treatment, and holistic care. Further research into novel therapeutic modalities and long-term outcomes remains essential in refining the management of this complex and debilitating complication of diabetes.
糖尿病足骨髓炎（DFO）给糖尿病患者的治疗带来了重大挑战，常常导致严重并发症和发病率增加。DFO的有效管理需要多学科方法，涉及内分泌科医生、传染病专家、血管外科医生、骨科医生和伤口护理专家。早期诊断至关重要，先进的成像技术如磁共振成像（MRI）和骨闪烁显像有助于实现早期诊断。一旦确诊，治疗策略取决于药物和手术干预的结合。根据培养结果指导的抗生素治疗在DFO管理中起着核心作用。针对特定病原体的定制方案通常会长期使用。当保守措施不足时，手术干预就变得必要。手术方法从微创程序（如经皮引流）到更广泛的干预措施（如清创和骨切除）不等。预防DFO复发同样重要，强调血糖控制、细致的足部护理、患者教育、对高危体征的监测、血管再通以及在有指征时进行早期干预。糖尿病足骨髓炎的管理需要一个全面的策略，既要解决该病症的感染方面，也要解决手术方面。协作性的跨学科方法可确保及时诊断、量身定制的治疗和全面护理。对新型治疗方式和长期结果的进一步研究对于完善这种复杂且使人衰弱的糖尿病并发症的管理仍然至关重要。
