Laing P
Wrexham Maelor Hospital, Clwyd, United Kingdom.
Am J Surg. 1998 Aug;176(2A Suppl):11S-19S. doi: 10.1016/s0002-9610(98)00182-2.
Neuropathy and ischemia, two common complications of diabetes mellitus, are the primary underlying risk factors for the development of foot ulcers and their complications. The presence of symmetric distal polyneuropathy, encompassing motor, sensory, and autonomic involvement, is one of the most important factors in the development of diabetic foot ulcers. Perhaps one third of diabetic foot ulcers have a mixed neuropathic and ischemic etiology. Although neuropathy and ischemia are the primary predisposing factors in the formation of diabetic foot ulcers, an initiating factor, such as physical or mechanical stress, is required for an ulcer to develop. Ischemic ulcers develop as a result of low perfusion pressure in a foot with inadequate blood supply, whereas neuropathic ulcers result from higher pressures in a foot with adequate blood supply but loss of protective sensation. In addition to increasing the risk of ulceration, diabetes mellitus also increases the risk of infection by impairing the body's ability to eliminate bacteria. The processes by which ulcers develop are reviewed here.
神经病变和缺血是糖尿病的两种常见并发症，是足部溃疡及其并发症发生的主要潜在危险因素。对称性远端多发性神经病变，包括运动、感觉和自主神经受累，是糖尿病足溃疡发生的最重要因素之一。大约三分之一的糖尿病足溃疡具有神经病变和缺血混合病因。虽然神经病变和缺血是糖尿病足溃疡形成的主要诱发因素，但溃疡的发生需要一个起始因素，如物理或机械性应激。缺血性溃疡是由于足部血液供应不足、灌注压力低所致，而神经病变性溃疡则是由于足部血液供应充足但保护性感觉丧失、压力较高所致。糖尿病除了增加溃疡形成的风险外，还通过损害身体清除细菌的能力增加感染风险。本文将对溃疡形成的过程进行综述。
