Landsman A S, Meaney D F, Cargill R S, Macarak E J, Thibault L E
Dr. William M. Scholl College of Podiatric Medicine, Chicago, IL 60610, USA.
J Am Podiatr Med Assoc. 1995 Oct;85(10):519-27. doi: 10.7547/87507315-85-10-519.
Foot ulcerations are one of the most common and dangerous complications associated with chronic diabetes mellitus. Many studies have focused on neuropathy, in conjunction with elevated ground reactive forces, as the principal cause of these ulcerations. The authors discuss the mechanical cause of diabetic ulcerations at the cellular level. It is hypothesized that increased rate of tissue deformation associated with foot slap secondary to progressive motor neuropathy is the actual culprit, and not the magnitude of local pressure applied. The authors present a cellular model that shows that high rates of tissue deformation may result in elevated intracellular calcium concentrations, which may lead to cellular death, while comparable loads gradually applied do not. Furthermore, there is no significant difference in the response observed at 5 psi and 10 psi. Based on these findings, it is hypothesized that techniques such as ankle foot orthoses, which control the velocity of foot strike, may be useful in treating diabetic foot ulcerations.
足部溃疡是慢性糖尿病最常见且危险的并发症之一。许多研究聚焦于神经病变以及增高的地面反作用力，将其视为这些溃疡的主要成因。作者们在细胞层面探讨了糖尿病溃疡的机械成因。据推测，继发于进行性运动神经病变的足拍击相关组织变形速率增加才是真正的罪魁祸首，而非局部施加压力的大小。作者们提出了一个细胞模型，该模型表明高组织变形速率可能导致细胞内钙浓度升高，进而可能导致细胞死亡，而逐渐施加的同等负荷则不会。此外，在5磅力/平方英寸和10磅力/平方英寸下观察到的反应并无显著差异。基于这些发现，据推测诸如控制足部着地速度的踝足矫形器等技术可能对治疗糖尿病足溃疡有用。
