由前跖区发展至跟结节的糖尿病足创面诊治分析  

Diagnosis and Treatment of Diabetic Foot Wounds Extended form Plantar to Heel

作　　者：王璐宁[1] 杨彩哲[1] 

机构地区：[1]空军总医院内分泌科,北京100142

出　　处：《临床误诊误治》2016年第11期66-70,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨糖尿病足(diabetic foot,DF)病变范围的评估方法,波及足跟结节软组织坏死的清创措施以及辅助负压封闭引流技术(vacuum sealing drainage,VSD)治疗DF创面时的注意事项。方法对2014年7月—2015年12月空军总医院内分泌科收治的2例重度感染DF的治疗过程进行回顾分析,总结其中的不足之处。结果本文2例入院时患足原始创面均位于前跖区,由于病情进展和创面处理不妥,患足创面均延伸至足跟区近心端,经抗感染、调整清创换药方式、适时辅助VSD及对症等治疗,分别历经5个月和7个多月,患足创面愈合。结论临床医师应熟知足部解剖结构,能够通过患者临床表现等,正确评估足部感染的严重程度,识别感染可能发展方向。DF创面清创应适度,尽可能保护足跟脂肪垫组织完整。足跟脂肪垫大部分暴露,且存在液化坏死或感染时,不适于应用VSD辅助治疗。Objective To investigate methods of evaluating extented disease of diabetic foot（ DF） infection,key points of DF debridement extended form plantar to heel and announcements of utilizing vacuum sealing drainage（ VSD） in treatment of diabetic foot ulcers（ DFUs）. Methods Therapeutic processes for 2 patients with serious DFUs during July 2014 and December 2015 were retrospectively analyzed,and insufficiency points were summarized. Results Because of disease progression and inappropriate wound treatment,wounds of the 2 patients extended form plantar at admission to proximal part of heel,and the wounds of 2 patients were cured by treatments such as anti-infection,dressing change for debridement,assisted VSD,symptomatic treatment and in time for 5 and 7 months respectively. Conclusion Clinicians should understand anatomic structure of foot clearly in order to evaluate DFU severity correctly and identify possible progression of disease by clinical manifestations of patients. DFU debridement should be appropriate so as to protect heel fat pads as far as possible. If heel fat pads are mainly exposed with liquefactive necrosis and infection,VSD is not the effective treatment for it.

关 键 词：糖尿病足 外科治疗 感染 

分 类 号：R587.2[医药卫生—内分泌] R641[医药卫生—内科学]