Outcomes of surgical treatment of diabetic foot osteomyelitis:: a series of 185 patients with histopathological confirmation of bone involvement
Outcomes of surgical treatment of diabetic foot osteomyelitis:: a series of 185 patients with histopathological confirmation of bone involvement
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DOI：
10.1007/s00125-008-1131-8
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发表时间：
2008-11-01
期刊：
影响因子：
8.2
通讯作者：
Armstrong, D. G.
中科院分区：
文献类型：
--
作者：
Aragon-Sanchez, F. J.;Cabrera-Galvan, J. J.;Armstrong, D. G.
目的/假设我们分析了决定糖尿病患者足部骨髓炎手术治疗结果的因素，糖尿病患者在入院后12小时内给予早期手术治疗，并优先进行足部保留手术和避免截肢。结果175例（94.5%）骨探查阳性，157例（84.8%）有骨髓炎征象。金黄色葡萄球菌是大多数培养物中分离的微生物（51.3%），在35例（36.8%）中证明是耐甲氧西林的。进行的手术治疗包括91例保守手术，这些手术被定义为不进行足部任何部分截肢的手术（49.1%）。共有94例患者接受了一定程度的截肢，包括79例足水平（小）截肢（42.4%）和15例大截肢（8%）。围手术期死亡5例（2.7%）。组织学分析显示94例（50.8%）急性骨髓炎，43例（23.2%）慢性骨髓炎，45例（24.3%）慢性骨髓炎急性加重，其余3例（1.6%）指定为“其他”。失败的风险，在保守手术的情况下，暴露骨，缺血和坏死的软组织infection.Conclusions/interpretation没有本地或高水平截肢保守手术是成功的，几乎一半的情况下，糖尿病足骨髓炎。应进行前瞻性试验，以确定保守性手术与其他方法的相对作用。
Aims/hypothesis We analysed the factors that determine the outcomes of surgical treatment of osteomyelitis of the foot in diabetic patients given early surgical treatment within 12 h of admission and treated with prioritisation of foot-sparing surgery and avoidance of amputation.Methods A consecutive series of 185 diabetic patients with foot osteomyelitis and histopathological confirmation of bone involvement were followed until healing, amputation or death.Results Probing to bone was positive in 175 cases (94.5%) and radiological signs of osteomyelitis were found in 157 cases (84.8%). Staphylococcus aureus was the organism isolated in the majority of cultures (51.3%), and in 35 cases (36.8%) it proved to be methicillin-resistant. The surgical treatment performed included 91 conservative surgical procedures, which were defined as those where no amputation of any part of the foot was undertaken (49.1%). A total of 94 patients received some degree of amputation, consisting of 79 foot-level (minor) amputations (42.4%) and 15 major amputations (8%). Five patients died during the perioperative period (2.7%). Histopathological analysis revealed 94 cases (50.8%) of acute osteomyelitis, 43 cases (23.2%) of chronic osteomyelitis, 45 cases (24.3%) of acute exacerbation of chronic osteomyelitis and three remaining cases (1.6%) designated as 'other'. The risks of failure in the case of conservative surgery were exposed bone, the presence of ischaemia and necrotising soft tissue infection.Conclusions/interpretation Conservative surgery without local or high-level amputation is successful in almost half of the cases of diabetic foot osteomyelitis. Prospective trials should be undertaken to determine the relative roles of conservative surgery versus other approaches.