糖尿病性骨病(附37例分析)

Diabetic Osteopathy (an analysis of 37 cases)

作者对37例糖尿病性骨病做了临床X线分析,指出本病好发于四肢骨端,足部占91.9％。主要临床表现为经久不愈的顽固性溃疡。糖尿病性骨坏疽是最重要的x线所见,其特征为:易发生在蹠趾骨骨端,溶骨性骨质破坏,周围无或很少骨膜反应,骨性关节面常保留。糖尿病性骨坏疽主要应同骨髓炎相鉴别。糖尿病性骨坏疽的病因很可能是由于糖的代谢紊乱而导致全身多方面的代谢失调及继发的神经血管病变。感染对骨坏疽可能起了催化剂的作用。

This paper reported the result of clinicoradiologic analysis of 37 patients with diabetic osteopathy. The site of predilection was the bony ends of the extremities, especially the foot (91.9%). The main clinical manifestation was the presence of a non-healing chronic ulcer, whereas diabetic gangrene of bone constituted the chief x-ray finding, which was characterized by osteolytic destruction at the bony ends of metatarsals and phalanges, with minimal periosteums reaction if any. The bony articular surfaces were usually preserved. The chief distinction to be made is osteomyelitis. The mechanism of diabetic osteopathy is most probably systemic metabolic disorders resulted from disturbance of carbohydrate metabolism with secondary neurovascular changes. Infection probably plays the role of enhancing effect in gangrene of bone.