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1、复旦学报(医学版)FudanUnivJMedSci2009Jul,36(4)465糖尿病足溃疡的性质及好发部位分析李青刘芳赵俊功赵珺曾辉董杨贾伟平(上海交通大学附属第六人民医院内分泌代谢科上海市糖尿病临床医学中心足病防治协作组上海200233)摘要!目的探讨糖尿病足溃疡的性质及其相关的病理生理机制,同时对糖尿病足溃疡的好发部位作初步分析。方法分析糖尿病足病门诊121例患者的溃疡诱因等基本情况,测量溃疡面积。通过浅感觉、腱反射、肌电图或振动感觉阈值(vibrationperception
2、threshold,VPT)检查周围神经病变(diabeticperipheralneuropathy,DPN);通过症状、下肢血管超声或磁共振显像判断有无周围血管病变。根据病变基础将溃疡分为神经性溃疡组(n=33)、缺血性溃疡组(n=27)和混合型溃疡组(n=61)。结果121例患者中97例(80.2%)溃疡发病部位为足趾与足底。神经性溃疡组中,48.5%病变部位于足底,30.3%位于足背,21.2%位于足趾。缺血性溃疡组中,溃疡位于足趾59.3%,足背29.6%,足底11.1%。混合性溃疡组的溃疡49.2%位于足趾,
3、41%位于足底,9.8%位于足背。3组的溃疡分布差异有显著性统计学意义(P<0.01)。3组中以混合型溃疡组患者年龄最大,糖尿病病程最长(P<0.05),诊断时溃疡面积最大,而缺血组的BMI与血压则较其余两组高(P>0.05)。结论病变发病基础不同可导致糖尿病足患病部位的不同,拇趾和足底为糖尿病足的高发部位。关键词!糖尿病足;溃疡分型;好发部位中图分类号!R587.2文献标志码!BAnapproachofdiabeticfootulcersnatureanditspredilectionsiteLIQing
4、,LIUFang,ZHAOJungong,ZHAOJun,ZENGHui,DONGYang,JIAWeiping(DepartmentofEndocrinology&Metabolism,SixthPeople∀sHospitalAffiliatedtoShanghaiJiaotongUniversity,ShanghaiClinicalCenterforDiabeticFootPreventionandCureCollaborativeGroup,ShanghaiInstituteforDiabetes,Shang
5、hai200233,China)Abstract!ObjectiveToinvestigatethefeatureofdiabeticfootulcerandtherelativemechanism,andtoanalyzeitspredilectionsite.MethodsTheprecipitatingfactorsandtheareasofulcerwereanalyzedin121diabeticpatientswithfootulcer.Theperipheralneuropathywasdiagnos
6、edbymeasuringtheskinsensation,tendonreflex,electromyogramorvibrationperceptionthreshold(VPT).Thediabeticperipheralneuropathy(DPN)wasevaluatedbypositivesymptoms,ultrasoundormagneticresonanceangiography.Accordingtomorbidchanges,thepatientsweredividedintoneuropathicu
7、lcergroup(n=33),ischemiculcergroup(n=27),andmixedtypeulcergroup(n=61).ResultsTheulcersof97cases(80.2%)weredistributedindigitalpedisandplantarpedis.Inneurogeniculcergroup,therewere48.5%lesionatplantapedis,30.3%atdorsumpedis,and21.2%atdigitipedi.Inischemiculcergro
8、up,therewere59.3%atdigitipedis,29.6%atdorsumpedis,and11.1%atplantapedis.Inmixedtypeulcergroup,therewere49.2%atdigitipedis,41%atplantapedis,and9.8%atdors
