136例糖尿病周围神经病变患者截肢原因及特点分析

Analysis of the causes and characteristic of amputation in diabetic patients with peripheral neuropathy

目的分析糖尿病周围神经病变(Diabetic peripheral neuropathy,DPN)患者截肢原因及特点,为防控DPN患者截肢提供初步资料。方法回顾性分析2所重庆综合性医院136例DPN病例截肢原因和特点。结果 DPN患者并发周围血管病变(peripheral arterial disease,PAD)时,其截肢的主要原因是足部骨髓炎(36.2%),其次为混合性坏疽(25%)和干性坏疽(18.1%),以上三者的比例均显著高于单纯DPN组;截肢以踝关节以下的居多(72.4%)。而单纯DPN患者截肢例数仅占全部例数的14.7%,其截肢的主要原因是湿性坏疽(65%),其比例显著高于与DPN合并PAD组,其次为夏科关节病(20%)和创伤(10%);截肢以踝关节以上的居多(85%),与DPN合并PAD组存在显著性差异。结论 DPN合并PAD时截肢风险增加,足部骨髓炎、混合性、干性坏疽是DPN合并PAD患者的主要截肢原因;湿性坏疽是DPN患者截肢的主要原因。DPN合并PAD时截肢多见于踝关节以下,而单纯性DPN截肢多在踝关节以上。

Objective To analyze the causes and characteristics of amputation in diabetic patients with peripheral neuropathy,in order to provide preliminary information to prevent the amputation.Methods 136 cases of diabetic patients with peripheral neuropathy treated with amputation were analyzed.Results The main reason for amputation of DPN patients with peripheral vascular disease（peripheral arterial disease,PAD） was foot osteomyelitis（36.2%）,followed by mixed gangrene（25%）,and dry gangrene（18.1%）,which was significantly higher than that DPN group.Locations of amputation in these patients were mainly below the ankle joint（72.4%）.The number of cases of amputation in patients with DPN alone accounted for only 14.7% of total number of cases,the amputation is mainly due to wet gangrene（65%）,the ratio was significantly higher than the DPN group merged with PAD,followed by Charcot joint disease（20%） and trauma（10%）.Locations of amputation in these patients were mainly above the ankle joint（85%）.Conclusion DPN increases risk of amputation in diabetic patients with PAD,and foot osteomyelitis,mixed and dry gangrene are the main reason for amputation.Wet gangrene is the main reason for amputation in patients with DPN alone.Amputation in DPN combined PAD patients is more common below the ankle joint while the amputation in patients with DPN alone above the ankle.