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21.
OBJECTIVE: To determine the mortality of a population of patients diagnosed with Charcot neuropathic osteoarthropathy managed by a single specialist unit and to compare the results with a control population. METHODS: We have undertaken a retrospective analysis of all cases of Charcot foot on the comprehensive database which has been maintained at the specialist diabetic foot clinic at the City Hospital, Nottingham since 1982. Survival and the incidence of amputation (major and minor) was compared with a control population referred with uncomplicated neuropathic ulceration. Controls were individually matched for gender, age (+/-2 years), disease type, disease duration (+/-2 years) and year of referral (+/-3 years). RESULTS: Forty-seven cases (21 female, 26 male) of Charcot foot were identified, of whom 18 (38.3%) had Type 1 diabetes. Mean age and disease duration at presentation were 59.2 +/- 13.4 (sd) and 16.2 +/- 11.2 years, compared with 59.7 +/- 12.6 and 16.3 +/- 11.2 years, respectively, in the controls. Twenty-one (44.7%) of those with Charcot had died, after a mean interval of 3.7 +/- 2.8 years. This compared with 16 (34.0%) after a mean 3.1 +/- 2.7 years in the control group. Mean duration of follow-up in the survivors was 4.7 +/- 4.9 years (Charcot) and 5.3 +/- 3.9 years (controls). A total of 11 (23.4%) Charcot patients had had a major amputation on the side of the index lesion, compared with five (10.6%) controls. There was no difference between the two groups (P > 0.05, Chi-square). CONCLUSIONS: The mortality in this group of patients with Charcot foot was higher than expected. Nevertheless, there was no difference between those with Charcot and those with uncomplicated neuropathic ulceration. It is possible that it is neuropathy, rather than Charcot osteoarthropathy, which is independently associated with increased mortality in diabetes. The mechanism underlying any such association is not known. There is a need for a formal, prospective, multicentre study to investigate the life expectancy and cardiovascular risk of those with Charcot osteoarthropathy. 相似文献
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G. RAYMAN S. A. WILLIAMS J. GAMBLE J. E. TOOKE 《European journal of clinical investigation》1994,24(12):830-836
Abstract. The effect of lowering the foot on the factors governing fluid filtration in the foot were studied in 12 male insulin-dependent diabetic subjects and 10 controls. Toe skin blood flow, measured by laser Doppler flowmetry, was significantly higher during dependency in the diabetic group. In the control subjects, the colloid osmotic pressure of venous blood sampled from the foot rose to 47·7 mmHg (range 45·1–53·8) after 50 min of foot dependency. In the diabetic group, colloid osmotic pressure failed to rise to the same extent (median 36·7 mmHg; range 28·6–43·0; P < 0·001). Capillary pressure, measured directly by the Landis microinjection technique, was significantly higher in the diabetic group (85·3±1·7 ( n = 6) vs. 92·2±4·6 cm H2 O ( n = 6); P < 0·007), as was foot swelling rate determined by mercury strain gauge plethysmography (0·069±0·022 vs. 0·099±0·025 ml min-1 100ml-1 ; P < 0·02). These results suggest an impairment of the oedema-preventing mechanisms in diabetic subjects which may contribute to the risks of ulceration in the diabetic foot. 相似文献
24.
胰激肽原酶治疗糖尿病足38例疗效分析 总被引:3,自引:0,他引:3
目的 观察胰激肽原酶改善微循环干预治疗糖尿病足的疗效。方法 选择38例确诊为糖尿病足的患者,结合下肢血管多普勒超声显像、肌电图、血液流变学检测,确定疗效。结果 胰激肽原酶治疗后,肢体影色多普勒超声显像显示下肢血管血流明显加快(P<0.01);神经电生理异常均有不同程度改善;血液粘度明显下降(P<0.01);足部症状明显缓解。结论 胰激肽原酶是一种干预糖尿病足进展的有效药物。 相似文献
25.
中药泡洗治疗糖尿病足90例疗效分析 总被引:1,自引:0,他引:1
目的为了观察中药泡洗对糖尿病足的疗效。方法对90例糖尿病足患者用中药(方剂组成:桃仁、红花、桂枝、没药、乳香、花椒、川芎等各10g)水煎制后分为2袋各300ml配合足浴仪泡洗,2次,d,30min/次,10d为1疗程。结果全组90例患者显效66例,有效24例,总有效率100%。结论中药泡洗治疗糖尿病足疗效确切。 相似文献
26.
Two cases of bipartite tarsal navicular bone are presented. The radiographic and computed tomography (CT) findings of this anatomical variant are described. Correct recognition of this entity is important, both because it may be the cause of symptoms perse, and because it may be misdiagnosed as a fracture. When plain films are not diagnostic, CT scanning is helpful in distinguishing between a fracture and this variant. 相似文献
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足新型矫形外固定器的研制与应用 总被引:8,自引:2,他引:6
[目的]报道一种足新型矫形外固定器的构成和临床应用效果,并与Illizarov外固定器进行对比。[方法]作者研制一种足新型矫形外固定器,由3对、6根金属杆组成,每根金属杆具有单独的延长、加压功能。利用固定在胫骨、跟骨、跖骨共4根克氏针,将小腿、足部两侧成三角形连接为一体,进行三维矫形。2004年1月以来,使用该外固定器治疗先天性和后天获得性、不同原因引起的132马蹄内翻足畸形。现将随访12个月以上病例62例(85足)予以报道。[结果]根据Garceau分级标准、结合患者足形态与功能表现评定:优:40足;良:40足;可:5足;差:无。优良率为94.1%。[结论]足新型三维矫形外固定器治疗幼儿、青少年马蹄内翻足安全、可靠、有效;比Illizarov外固定器结构简单,安装方便、省时;患者感到舒适,轻便;成本低、价格便宜;适合国内有条件的医疗单位广泛应用。 相似文献
29.
The human foot is a complex mechanical structure consisting of bones, ligaments and joints. They act together to provide a robust system capable of absorbing and dissipating the intermitted pressure that is subjected to its plantar surface during walking to prevent soft tissue breakdown. Current studies suggest that plantar foot pressure may lead to soft tissue breakdown (e.g. neuropathic ulceration) and hence research has so far concentrated on investigating the mechanical effects of plantar foot pressure on the foot’s integrity. This has been possible through the widely available pressure and force platforms as well as in-shoe pressure systems. However, to understand how plantar foot pressure causes soft tissue breakdown it is vital to investigate both the physiological–mechanical interactions between the skin and plantar foot pressure. This review suggests that with the current advances in technology, the physiological response of skin blood flow to mechanical plantar foot pressure should be investigated and correlated further, both during static and dynamic loading, by developing a new system capable of either measuring both variables simultaneously or by synchronising two systems in real time. 相似文献
30.