【摘要】 目的探讨糖尿病足(DF)小截肢的影响因素。方法回顾性分析236例全部为单侧DF患者包括DF局部特征在内的影响因素,并记录小截肢结局,筛选小截肢独立影响因素。局部特征以感染广度(W)、感染深度(D)、循环(C)及坏疽(G)进行评价,W分为无感染或仅足体累及、足趾累及、足趾+跖趾关节累及、足趾+跖趾关节+足体累及;D分为无感染、浅层感染(仅累及皮肤、皮下组织)、中层感染(累及肌肉、肌腱)、深层感染(累及骨、关节);C在本研究中以踝肱指数(ABI)绝对值评价;坏疽(G)分为无坏疽、有坏疽。结果高白蛋白(OR 0.890,95%CI 0.819～0.967,P=0.006)和ABI(OR 0.163,95%CI 0.052,0.506,P=0.002)是小截肢的独立保护因素;高W(OR 1.787,95%CI1.197～2.668,P=0.005)和D(OR 4.932,95%CI 2.370～10.265,P=0.000),是DF小截肢的独立危险因素;合并坏疽时DF小截肢风险更高(P=0.000)。结论局部特征在DF小截肢中起重要作用。更多还原

【Abstract】 Objective To explore the influencing factors of diabetic foot(DF)minor amputation.Methods 236 patients with DF were included retrospectively. All patients had unilateral DF. The influence factors including DF local characteristics were collected and the results of minor amputation were recorded.The independent influencing factors of minor amputation were selected. Local characteristics were evaluated according to infection width(W),infection depth(D),circulation(C)and gangrene(G). W were divided into no infection or only foot involvement,toe involvement,toe+metatarsophalangeal joint involvement and toe + metatarsophalangeal joint + foot involvement. D were divided into no infection,superficial infection(involving only skin and subcutaneous tissue),middle infection(involving muscles and tendons)and deep infection(involving bone and joint). C was evaluated according to the absolute value of ankle brachial index(ABI). G was divided into no gangrene and gangrene.Results Higher level of ALB(OR 0. 890,95%CI 0. 819～0. 967,P=0. 006)and ABI(OR 0. 163,95%CI 0. 052～0. 506,P=0. 002)were independent protective factors for minor amputation. Wider W(OR 1. 787,95%CI 1. 197～2. 668,P=0. 005),deeper D(OR 4. 932,95%CI 2. 370～10. 265,P=0. 000)were independent risk factors for minor amputation. DF minor amputation risk was higher in patients with gangrene than those without gangrene(P=0. 000).Conclusion Local characteristics played an important role in predicting DF minor amputation.更多还原