中国糖尿病足截肢(趾)治疗专家共识(2022年版)  

Expert consensus on the treatment of diabetic foot amputation (toe) in China (2022 version)

作　　者：中国老年医学学会烧创伤分会 中国生物材料学会烧创伤创面修复材料分会 廖选[2] 李升红[2] 刘宏伟[2] 黄跃生 付小兵[4] Burns and Trauma Wound Repair Materials Branch of Chinese Biomaterials Society;Burns and Trauma Branch of Chinese Geriatrics Society;Liao Xuan;Li Shenghong;Liu Hongwei;Huang Yuesheng;Fu Xiaobing(不详;Department of Plastic Surgery,First Affiliated Hospital of Jinan University,Institute of New Technology of Plastic Surgery of Jinan University,Key Laboratory of Regenerative Medicine of Ministry of Education,Guangzhou 510630,China;Department of Wound Repair,Southern Uninersity of Science and Technology Hopital,Instiute of Wound Repair and Regeneraton Medicine,Southermn.Unirmirof Sine and Tonomboy Sthod of Medine,Shenzhen 518055;Research Center for Wound Repair and Tissue Regeneration,Medical Innovation Research Department,the PLA Genceral Hospital,Beijing 100853)

机构地区：[1]不详 [2]暨南大学附属第一医院整形外科,暨南大学整形外科新技术研究所再生医学教育部重点实验室,广州510630 [3]南方科技大学医院创面修复科,南方科技大学医学院创面修复与再生医学研究所,深圳518055 [4]解放军总医院医学创新研究部创伤修复与组织再生研究中心,北京100853

出　　处：《中华损伤与修复杂志（电子版）》2023年第1期1-9,共9页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：国家自然科学基金(81871563,82102345);广东省重点领域研发计划项目(2022B1111080007);广东省基础与应用基础研究基金(2019A1515110161);中央高校基本科研业务费专项项目(21619350);广州市科技计划资助项目[市校(院)联合资助(高水平大学)基础研究项目](202201020002,202201020004,202201020468);广东省医学科研基金项目(A2021165);暨南大学附属第一医院临床前沿技术项目(JNU1AF-CFTP-2022-a01231,JNU1AF-CFTP-2022-a01208)。

摘　　要：糖尿病足是糖尿病最常见、最严重的并发症。统计数据表明,糖尿病患者一生中发生足部溃疡的风险高达25%,其中有14%~24%的足部溃疡患者需行截肢(趾)治疗。目前,尽管对于严重肢(趾)体坏疽创面或感染等,截肢(趾)可以控制感染、促进愈合、挽救患者生命,但其同时也将严重影响患者的自主步态、生活方式、生存质量甚至预后,特别是大截肢患者,5年生存率仅约30%。因此,正确选择是否截肢(趾)、确定截肢(趾)平面、力争截肢(趾)后创面尽早愈合,对于糖尿病足的治疗有着非常重要的临床意义。近年来,国内外已有关于糖尿病足治疗的专家共识或指南、截肢(趾)治疗的基本原则等指导性意见,但如何确定糖尿病足患者是否需要截肢(趾),需要大截肢还是小截肢(趾),以及具体截肢(趾)平面的确定等仍存在诸多争议。鉴于截肢(趾)无论对于患者还是医师都需慎重考虑才能做出决定,为尽可能规范截肢(趾)治疗这一糖尿病足治疗的重要手段,专家组主要从糖尿病足截肢(趾)治疗相关问题进行讨论形成共识,为从事糖尿病足治疗的创面修复科医师提供参考。本共识达成的每项建议均通过至少95%相关领域专家的总结与认同,并参考分级评估、发展与评价(GRADE)系统对现有的证据质量和推荐强度进行分级。对于未能达成共识的相关问题,将通过密切关注国内外关于糖尿病足研究进展和专家的经验,后期组织相关领域专家更新共识内容。Diabetic foot is one of the most common and serious complications of diabetes.Statistics show that diabetics have a 25%percent lifetime risk of developing foot ulcers,with 14%to 24%of patients requiring amputation(toe)treatment.At present,although amputation(toe)therapy can control wound infection,promote wound healing,and save patients′lives for severe limb(toe)gangrene wounds and necrotic limb(toe)infection,and it can also affect patients′voluntary gait,lifestyle,quality of life,and even prognosis;especially for wide range amputees,the 5-year survival rate is only about 30%.Therefore,the correct choice of amputation or not,the correct determination of the amputation plane,and strive for the primary wound healing after amputation have very important clinical significance for the treatment of diabetic foot.In recent years,there have been the experts consensus or guidelines on the treatment of diabetic foot,as well as guiding opinions on the basic principles of amputation(toe)treatment at home and abroad,however,it is still controversial on how to determine whether diabetic foot patients need amputation(toe),large or small amputation(toe)is required,as well as the amputation(toe)plane.Given that amputation(toe)is a decision that requires careful consideration for both the patient and the surgeon,in order to standardize amputation(toe)management,which is an important method for the treatment of diabetic foot,the expert group mainly discussed and reached a consensus on issues related to amputation(toe)treatment of diabetic foot,to provide a reference for wound specialist engaged in the treatment of the diabetic foot.Each consensus reached in this consensus is summarized and recognized by at least 95%of experts in relevant fields,and the existing evidence quality and recommendation strength are graded with reference to the Grades of Recommendations Assessment,Development and Evaluation(GRADE)system.For issues that fail to reach consensus,we will pay close attention to the advances in diabetic foot ulcer therapy,a

关 键 词：糖尿病足 截肢术 伤口愈合 专家共识 

分 类 号：R58[医药卫生—内分泌]