平衡足底压力及稳定步态在早期糖尿病足防治中的意义  

Significance of Plantar Pressure Balance and Gait Stability in Early Prevention and Cure of Diabetic Foot

作　　者：胡伊玢[1] 孟晓静[2] 

机构地区：[1]南方医科大学南方医院,广东省广州市510515 [2]南方医科大学公共卫生与热带医学学院

出　　处：《中国全科医学》2013年第17期1959-1963,共5页Chinese General Practice

摘　　要：目的探讨平衡足底压力及稳定步态在早期糖尿病足防治中的临床意义。方法选取2010—2011年我院收治的糖尿病足患者42例,Wagner分级均为0级。将患者按随机数字表法分为治疗组和对照组,每组21例。采用比利时Footscan足底压力步态分析系统对两组患者进行动态足底压力及静态冲量监测,治疗组患者根据足底压力监测数据制定个性化方案平衡足底压力。对照组患者采用常规治疗方案,不采取个性化足底压力平衡改善方案。对两组患者进行1年的随访,观察治疗前后两组患者足底压力、步态稳定曲线、足溃疡发生率、冲量等。结果治疗前两组患者足底各区域压力比较,差异无统计学意义(P>0.05);治疗1年后,对照组患者第三、四、五跖骨(M3、M4、M5)底部压力均高于本组治疗前及治疗组治疗后,而第一跖骨(M1)、第二跖骨(M2)、第一脚趾(T1)、足跟(H)区域的压力则低于治疗组,两组比较差异均有统计学意义(P<0.05);而治疗组患者足底各区域压力与本组治疗前比较,差异无统计学意义(P>0.05)。治疗后对照组步态平衡曲线有明显波动,压力重心分布曲线稍欠平滑即步态稳定性欠佳;而治疗组患者步态平衡曲线未见明显波动,足底压力分布较均衡。治疗后对照组、试验组足溃疡发生率分别为42.9%(9/21)和14.3%(3/21),冲量>65%者比例分别为42.9%(9/12)和14.3%(3/21),两组间比较差异有统计学意义(P<0.05)。结论糖尿病足足底压力的改变是糖尿病足溃疡发生的重要原因之一,早期对糖尿病患者足底压力进行评估,同时采用积极有效的平衡足底压力的措施,可降低足溃疡发生率,从源头上减少截肢率,保障了糖尿病患者的生活质量。Objective To explore the clinical significance of plantar pressure equilibrium and gait stability in early prevention and treatment of diabetic foot （DF）. Methods Forty - two DF patients （ Wanger classification = O） were divided randomly into groups therapy and control, 21 in each. Belgian -footsean plantar pressure gait detection system was used to monitor dynamical plantar pressure and static impulse in 2 groups, and then made personalized programs to balance plantar pres-sure based on the monitoring data in therapy group. Control group received conventional treatment without personalized programs. Two groups were followed up for 1 year, to observe the plantar pressure, gait stability curve, incidence of foot ulcers, impulse before and after treatment. Results No significant difference in plantar pressure between 2 groups before treatment （P 〉 0. 05 ）. After 1 year of treatment, the pretreatment pressures of the 3rd, 4th, 5th metatarsal base of control group were higher than those in control group before treatment and those in therapy group after treatment, the differences were significant （P 〈 0. 05）. There was no significant difference in plantar pressure in therapy group between post - and pre - treatments （ P 〉 0. 05 ）. After treatment, the gait balance curve fluctuated remarkably and gravity pressure distribution curve was a little short of smoothness （namely gait stability was not good） in control group, while in therapy group no obvious fluctuation was noted, the plantar pressure distribution was balanced. The incidences of foot ulcers were 42. 9% （9/21） in control group, 14. 3% （3/ 21 ） in therapy group, the difference was significant （P 〈0. 05）. There was significant difference in the proportion of impulse 〉 65% [42.9% （9/21） vs. 14.3% （3/21）] between control group and therapy group （P〉0.05）. Conclusion Plantar pressure change is one of the important causes of diabetic foot ulcers. Early detection and evaluation of plantar pressure of diabet-

关 键 词：糖尿病足 足底压力 步态 冲量 足溃疡 

分 类 号：R587.25[医药卫生—内分泌]