糖尿病足溃疡患者足趾截肢与保趾手术后临床结局的比较
Comparing Clinical Outcomes after Toe Amputation and Toe-Sparing Surgery in Patients with Diabetic Foot Ulcer.
作者信息
Yeganeh Ali, Kalantar Motamed Alireza, Baghbani Salar, Cheraghiloohesara Sahand, Gorgani Milad, Soleimani Mohammad
机构信息
Department of Orthopedic Surgery, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Department of General Surgery, Rasoul-e-Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
出版信息
Med J Islam Repub Iran. 2025 Feb 27;39:32. doi: 10.47176/mjiri.39.32. eCollection 2025.
BACKGROUND
Diabetic ulceration leads to amputation in up to 85% of cases. Managing a diabetic ulcer requires an expert team to prevent wound progression and apply proper supportive procedures, decreasing the risk of amputation. This study aimed to compare the clinical efficacy of toe-sparing surgery and toe amputation in patients with diabetic foot ulcers.
METHODS
This cohort evaluated 54 consecutive patients with Diabetes Mellitus and chronic ulcers in the lower extremities. The patients were treated by bone resection with preserving toe and soft tissue or complete toe amputation. They were followed up for one year. We evaluated the relative risk for re-ulceration of the same toe, ulcers in other parts, increased levels of hemoglobin A1c (HbA1c), and infection between the two groups.
RESULTS
The re-ulceration rate at the same toe was 12.9% in the toe amputation and 39.1% in the toe-sparing group ( < 0.001). The prevalence of other amputations in the toe amputation and toe-sparing surgery groups was 29.0% and 17.4%, respectively ( < 0.001). However, the infection rate was lower in the toe-sparing group ( < 0.001).
CONCLUSION
The re-ulceration rate was lower after toe amputation, and the infection rate was higher in the toe amputation group.
背景
糖尿病溃疡在高达85%的病例中会导致截肢。处理糖尿病溃疡需要一个专家团队来防止伤口进展并实施适当的支持性程序，以降低截肢风险。本研究旨在比较保留趾手术和趾截肢术在糖尿病足溃疡患者中的临床疗效。
方法
该队列研究评估了54例连续性糖尿病和下肢慢性溃疡患者。患者接受保留趾骨和软组织的骨切除术或完全趾截肢术治疗。对他们进行了为期一年的随访。我们评估了两组中同一趾再次溃疡、其他部位溃疡、糖化血红蛋白（HbA1c）水平升高以及感染的相对风险。
结果
趾截肢组同一趾的再次溃疡率为12.9%，保留趾组为39.1%（<0.001）。趾截肢组和保留趾手术组其他截肢的发生率分别为29.0%和17.4%（<0.001）。然而，保留趾组的感染率较低（<0.001）。
结论
趾截肢术后再次溃疡率较低，趾截肢组的感染率较高。
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