Armstrong D G, Hussain S K, Middleton J, Peters E J, Wunderlich R P, Lavery L A
Department of Orthopaedics, University of Health Science Center, San Antonio, Texas 78284-7776, USA.
Ostomy Wound Manage. 1998 May;44(5):70-4, 76.
Vibration perception threshold (VPT) values, measured at different anatomic locations on the foot and ankle, and the time to assess VPT and sensory perception using two difference modalities in 102 diabetic patients were compared. VPT was evaluated at the great toe, fifth metatarsal and ankle. Differences in VPT at these three sites, in addition to differences in duration of testing comparing single site (great toe) to multiple sites, and to standard SWMF testing were assessed. No significant difference in VPT between the great toe and fifth metatarsal was found for patients both with and without loss of protective sensation (LOPS). Mean VPT was significantly higher at the ankle compared with both the great toes and fifth metatarsals. However, the difference between ankle and great toe was not significant between patients with and without LOPS [3.9 +/- 11.2 (12%) vs. 3.0 +/- 10.8 (16%) volts, respectively, p > 0.6]. Testing of one site took approximately half the time of Semmes-Weinstein 10-gram monofilament wire SWMF testing (40.5 +/- 16.9 vs. 22.3 +/- 9.1 seconds, p < 0.01) and less than one third the time of three-site VPT testing (10.5 +/- 26.1 vs. 22.3 +/- 9.1 seconds, p < 0.01). There may not be a significant practical benefit in multiple site VPT testing when compared with single site testing on the great toe alone. The value of multiple site testing is further called into question when one notes that the great toe VPT remains the only site tested for sensitivity and specificity for ulceration.
比较了102例糖尿病患者在足部和踝部不同解剖位置测量的振动觉阈值（VPT）值，以及使用两种不同方式评估VPT和感觉知觉的时间。在拇趾、第五跖骨和踝部评估VPT。评估了这三个部位VPT的差异，以及比较单部位（拇趾）与多部位测试以及标准Semmes-Weinstein单丝纤维（SWMF）测试时测试持续时间的差异。对于有和没有保护性感觉丧失（LOPS）的患者，拇趾和第五跖骨之间的VPT没有显著差异。与拇趾和第五跖骨相比，踝部的平均VPT显著更高。然而，有和没有LOPS的患者踝部与拇趾之间的差异不显著[分别为3.9±11.2（12%）伏特和3.0±10.8（16%）伏特，p>0.6]。单部位测试所需时间约为Semmes-Weinstein 10克单丝纤维SWMF测试时间的一半（40.5±16.9秒对22.3±9.1秒，p<0.01），不到三部位VPT测试时间的三分之一（10.5±26.1秒对22.3±9.1秒，p<0.01）。与仅在拇趾进行单部位测试相比，多部位VPT测试可能没有显著的实际益处。当人们注意到拇趾VPT仍然是唯一用于溃疡敏感性和特异性测试的部位时，多部位测试的价值就更值得怀疑了。
