糖尿病Charcot足患者临床特点及预后

Clinical characteristics and prognosis of diabetes Charcot foot

目的 总结20例糖尿病Charcot足患者临床表现及预后,以提高临床医师对该病的认识.方法 回顾性分析空军总医院2008年6月至2013年6月诊断的20例糖尿病Charcot足患者临床特点及预后情况.结果 20例糖尿病Charcot足均为单足病变,患者平均年龄（55±8）岁,男性占75.0％（15/20）;糖尿病病史（12±6）年,患足血供可,足畸形前存在对称性麻木中位时间6年,血糖控制不佳,血脂基本正常.糖尿病慢性并发症中以微血管病变为主,以并发糖尿病肾病、糖尿病自主神经病变为多,分别占65.0％ （13/20）、75.0％ （15/20）.4例行小腿中上1/3截肢术、7例行截趾术、1例行患足第1跖跗单关节内置固定螺丝整形手术;6例换药,创面愈合;1例踝部创面好转出院;1例患足无溃疡,予以配置矫正鞋.随访1～5年,1例死于心肌梗死;1例因心房颤动引发脑梗死卧床;2例因尿毒症开始透析;1例患足原创面再次破溃;1例失访;余患者拄拐或轮椅助行,无糖尿病足溃疡.结论 男性为糖尿病Charcot足相对高发人群;多存在血糖控制不佳;早期患足减压、制动,均利于保护患足和促进足部创面愈合.

Objective To analyze the characteristics and prognosis of 20 patients with diabetes Charcot foot.Methods The clinical characteristics and prognosis of 20 patients with diabetes Charcot foot from June 2008 to June 2013 were retrospectively analyzed.Results All the 20 cases had single foot lesion;the age was （55 ± 8） years old;75.0% （15/20） were male;the mean duration of diabetes was （12 ±6） years;the blood supply of affected food was fine;the median duration of symmetry numbness was 6 years;the glycemic control was poor;the blood lipid was normal.The chronic complications were mostly microvascular disease,especially nephropathy [65.0% （13/20）] and autonomic nerve pathological change [75.0% （15/20）].Four cases underwent amputation of 1/3 of lower leg,7 cases underwent toes amputation,1 case underwent internal fixation of the first tarsometatarsal joint;6 cases were healed after debridement,1 case was improved;1 case put on configurated correction shoes.After 1-5 years of follow up,1 case died from heart attack,1 case had stroke induced by atrial fibrillation,2 cases underwent hemodialysis because of uremia,1 case had recurrent ulcers,1 case was lost,the others were well.Conclusions The male is high-risk population of diabetes Charcot foot associated with poor glycemic control mostly;decompression and immobilization of affected food favors protection and healing of Charcot foot.