Jung V
Medizinische Abteilung für Ernährung und Stoffwechsel der Medizinischen Universitätsklinik Düsseldor.
Zentralbl Chir. 1996;121(5):387-92; discussion 392-3.
In 35 patients with diabetic gangrene, amputation above the ankle (n = 18) or below the ankle (n = 17) was planned by nonspecialised general surgical departments or practicing surgeons. Prior to the operation, these patients presented to a specialised diabetic foot clinic; their clinical courses were analysed retrospectively.
in 14 cases, peripheral arterial occlusive disease (PAOD) stage IV was the underlying cause, which was treated by bypass-surgery in 10 cases and by angioplasty in 1 case. In 2 cases, bypass-operation was impossible due to anatomic conditions, and in 1 case it failed (all 3 cases were amputated below knee). In 21 patients, neuropathic infection was the underlying cause (without PAOD), which was unrecognized. In 13/21 cases osteomyelitis, and in 7/21 cases Charcot-foot was present. Treatment consisted of drainage, pressure relief, antibiotics, and minor amputations (3 toes, 3 midfoot).
in our retrospective analysis, 83% of major amputations that had been considered by non-specialised surgeons, could be prevented by a combined medical and vascular surgical approach. 79% of the minor amputations that had been considered, proved to be unnecessary. Thus, salvage of the gangrenosis diabetic foot is possible in the majority of cases, provided suitable vascular surgery and infection containment. The traditional high amputation rate in diabetic patients seems to be unfounded.
35例糖尿病坏疽患者由非专科普通外科或执业外科医生计划进行踝关节以上(n = 18)或踝关节以下(n = 17)截肢。术前,这些患者就诊于专门的糖尿病足诊所;对其临床病程进行回顾性分析。
14例患者潜在病因是外周动脉闭塞性疾病(PAOD)IV期,其中10例行搭桥手术,1例行血管成形术。2例因解剖条件无法行搭桥手术,1例手术失败(这3例均在膝关节以下截肢)。21例患者潜在病因是神经性感染(无PAOD),未被识别。21例中有13例存在骨髓炎,7例存在夏科氏足。治疗包括引流、减压、抗生素及小截肢(截3个趾、3个中足)。
在我们的回顾性分析中,非专科外科医生曾考虑的83%的大截肢可通过药物与血管外科联合治疗方法避免。曾考虑的小截肢中有79%被证明是不必要的。因此,多数情况下糖尿病坏疽足可通过合适的血管手术和控制感染得以挽救。糖尿病患者传统的高截肢率似乎没有依据。