Abstract：
BACKGROUND: Diabetic foot ulcers (DFUs) are a challenging complication of diabetes mellitus, often leading to poor clinical outcomes and significant socioeconomic burdens. We evaluated the effectiveness of a definitive single-stage protocolized surgical management pathway, including the use of local antibiotic bone graft substitute, for the treatment of infected DFUs with associated osteomyelitis.
METHODS: A retrospective cohort study was conducted. Medical records were extracted (from January 2017 to December 2020) to establish a database consisting of patients who underwent surgical intervention for the treatment of an infected DFU with osteomyelitis. Patients were divided into conventional (control) and protocolized (intervention) surgical groups depending on the treatment received. Clinical outcomes were assessed over a 12-month follow-up period.
RESULTS: A total of 136 consecutive patients were included (conventional = 33, protocolized = 103). The protocolized group demonstrated a statistically significant reduction in the mean number of operations performed per patient (1.2 vs. 3.5) (P < 0.001) and a shorter accumulative hospital length of stay (12.6 vs. 25.1 days) (P < 0.001) compared to the conventional group. Major amputation rates were significantly lower in the protocolized group (2% vs. 18%) (P < 0.001). Within 12 months of surgical intervention, the protocolized group exhibited an ulcer healing rate of 89%, with a low rate of recurrence (3%).
CONCLUSIONS: The protocolized surgical pathway, including local antibiotic bone graft substitute use, demonstrated superior outcomes compared to conventional management for the treatment of infected DFUs with osteomyelitis. Further research is needed to evaluate the cost-effectiveness and generalizability of this approach.
METHODS: A retrospective cohort study was conducted. Medical records were extracted (from January 2017 to December 2020) to establish a database consisting of patients who underwent surgical intervention for the treatment of an infected DFU with osteomyelitis. Patients were divided into conventional (control) and protocolized (intervention) surgical groups depending on the treatment received. Clinical outcomes were assessed over a 12-month follow-up period.
RESULTS: A total of 136 consecutive patients were included (conventional = 33, protocolized = 103). The protocolized group demonstrated a statistically significant reduction in the mean number of operations performed per patient (1.2 vs. 3.5) (P < 0.001) and a shorter accumulative hospital length of stay (12.6 vs. 25.1 days) (P < 0.001) compared to the conventional group. Major amputation rates were significantly lower in the protocolized group (2% vs. 18%) (P < 0.001). Within 12 months of surgical intervention, the protocolized group exhibited an ulcer healing rate of 89%, with a low rate of recurrence (3%).
CONCLUSIONS: The protocolized surgical pathway, including local antibiotic bone graft substitute use, demonstrated superior outcomes compared to conventional management for the treatment of infected DFUs with osteomyelitis. Further research is needed to evaluate the cost-effectiveness and generalizability of this approach.
摘要：
背景：糖尿病足溃疡（DFU）是糖尿病的一种具有挑战性的并发症，通常导致不良的临床结果和重大的社会经济负担。我们评估了确定的单阶段原型手术管理途径的有效性，包括使用局部抗生素骨移植替代品，用于治疗感染的DFU与相关骨髓炎。
方法：进行回顾性队列研究。提取医疗记录（从2017年1月至2020年12月），以建立一个数据库，该数据库由接受手术干预以治疗感染的DFU骨髓炎的患者组成。根据所接受的治疗，将患者分为常规（对照）和原型（干预）手术组。在12个月的随访期内评估临床结果。
结果：共纳入136例连续患者（常规=33例，常规=103例）。原型组显示出每位患者平均手术次数的统计学显着减少（1.2vs.3.5)(P<0.001)和较短的累计住院时间(12.6vs.与常规组相比，25.1天）（P<0.001）。原生质组的主要截肢率显着降低（2％vs.18%)(P<0.001)。在手术干预的12个月内，原生质化组溃疡愈合率为89%，复发率低（3％）。
结论：规范的手术途径，包括局部抗生素骨移植替代品的使用，与常规治疗相比，在治疗感染的DFU合并骨髓炎方面表现出更好的结局。需要进一步的研究来评估这种方法的成本效益和普遍性。
方法：进行回顾性队列研究。提取医疗记录（从2017年1月至2020年12月），以建立一个数据库，该数据库由接受手术干预以治疗感染的DFU骨髓炎的患者组成。根据所接受的治疗，将患者分为常规（对照）和原型（干预）手术组。在12个月的随访期内评估临床结果。
结果：共纳入136例连续患者（常规=33例，常规=103例）。原型组显示出每位患者平均手术次数的统计学显着减少（1.2vs.3.5)(P<0.001)和较短的累计住院时间(12.6vs.与常规组相比，25.1天）（P<0.001）。原生质组的主要截肢率显着降低（2％vs.18%)(P<0.001)。在手术干预的12个月内，原生质化组溃疡愈合率为89%，复发率低（3％）。
结论：规范的手术途径，包括局部抗生素骨移植替代品的使用，与常规治疗相比，在治疗感染的DFU合并骨髓炎方面表现出更好的结局。需要进一步的研究来评估这种方法的成本效益和普遍性。
