本研究的目的是评估糖尿病足骨髓炎(DFO)患者的预后,比较有和没有外周动脉疾病(PAD)的受试者。该研究是一项前瞻性研究,包括受前脚DFO影响的患者群体。所有患者均通过手术保守方法进行管理,该方法通过切除感染的骨骼来定义。与抗生素治疗相关。患者分为两组:PAD(神经缺血性DFO)和无PAD(神经性DFO)的患者。随访1年后,以下结果进行了评估和组间比较:愈合,愈合时间,轻微截肢,严重截肢,住院治疗,需要手术再干预。总的来说,166名患者被纳入,其中87例(52.4%)患有神经缺血性DFO,79例(47.6%)患有神经性DFO。与神经病性DFO相比,神经缺血性DFO患者年龄较大(72.5±9vs64.1±15.5年,P<.0001),糖尿病病程较长(21.8±5.6vs16.4±7.6年,P<.0001),较高的透析率(13.8vs1.3%,P=.001)和缺血性心脏病(79.3vs12.7%,P<.0001)。神经缺血性DFO和神经病性DFO的结果是:愈合(96.5vs97.5%,P=.7),愈合时间(7.8±6.2vs5.7±3.7周,P=.01),轻微截肢(16.1vs3.8%,P=.006),大截肢(0vs0%,ns),住院治疗(90.8vs51.9%,P<.0001),手术再干预(14.9%vs8.8%,分别为P=.004)。此外,PAD导致轻微截肢的独立预测因子,住院治疗,和手术再干预。PAD患者DFO的特点是愈合时间较长,更多的轻微截肢病例,住院治疗,和手术再干预。PAD独立预测轻微截肢的风险,住院治疗,和手术再干预,而与治愈率无关。
The aim of the current study was to evaluate the outcomes of patients with diabetic foot osteomyelitis (DFO), comparing subjects with and without peripheral arterial disease (PAD). The study is a prospective study including a population of patients affected by a DFO located in the forefoot. All patients were managed by a surgical conservative approach defined by the removal of the infected bone, in association with the antibiotic therapy. Patients were divided into two groups: those with PAD (neuro-ischaemic DFO) and those without (neuropathic DFO). After 1 year of follow-up, the following outcome were evaluated and compared between groups: healing, healing time, minor amputation, major amputation, hospitalization, need for surgical re-intervention. Overall, 166 patients were included, 87(52.4%) of them had neuro-ischaemic DFO and 79 (47.6%) neuropathic DFO. Patients with neuro-ischaemic DFO in comparison to neuropathic DFO were older (72.5 ± 9 vs 64.1 ± 15.5 years, P < .0001), had longer diabetes duration (21.8 ± 5.6 vs 16.4 ± 7.6 years, P < .0001), higher rate of dialysis (13.8 vs 1.3%, P = .001) and ischaemic heart disease (79.3 vs 12.7%, P < .0001). Outcomes for neuro-ischaemic DFO and neuropathic DFO were: healing (96.5 vs 97.5%, P = .7), healing time (7.8 ± 6.2 vs 5.7 ± 3.7 weeks, P = .01), minor amputation (16.1 vs 3.8%, P = .006), major amputation (0 vs 0%, ns), hospitalization (90.8 vs 51.9%, P < .0001), surgical re-intervention (14.9 vs 8.8%, P = .004) respectively. In addition, PAD resulted in an independent predictor of minor amputation, hospitalization, and surgical re-intervention. DFO in patients with PAD was characterized by longer healing time, more cases of minor amputation, hospitalization, and surgical re-intervention. PAD independently predicted the risk of minor amputation, hospitalization, and surgical re-intervention, while it was not associated with the healing rate.