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糖尿病足(Diabetic foot)的发生除了与周围神经病变、血管病变、感染等因素有关外,还与足部胼胝的形成有很大的关系。足底胼胝的存在增加了足底压力,胼胝下的正常组织由于受到过度持续的挤压而极易发生病变产生溃疡,严重时溃疡可并发感染,甚至导致截肢。溃疡表面的胼胝质地坚硬、与周边组织紧密粘边,难以去除,这给溃疡的愈合造成困难。本文报道1例高龄糖尿病患者因足底胼胝致使深度溃疡合并感染的病例,经过6周时间,精心护理,溃疡愈合。 相似文献
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《临床护理杂志》2016,(6)
目的分析个性化足减压护理在顽固性糖尿病压力性足溃疡中的安全性和有效性。方法选取2013年1月~2016年1月我科住院符合顽固性糖尿病压力性足溃疡患者78例,随机分为减压组和非减压组,各39例。非减压组采用基础治疗。减压组采用基础治疗联合个性化足减压护理。比较两组治疗创面愈合时间及治疗总有效率。结果经规范治疗3月后,减压组胼胝下感染、胼胝下合并足趾间感染愈合时间短于非减压组,两组比较差异有统计学意义(P0.05)。治疗总有效率高达94.9%,显著高于非减压组,两组比较差异有统计学意义(P0.05)。结论根据足底压力,提供个性化的足底减压护理,如合适的减压垫、减压鞋和配套的鞋垫,可有效促进糖尿病压力性足溃疡的愈合,缩短足溃疡愈合时间。 相似文献
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糖尿病足的发生除了与周围神经病变、血管病变、感染等因素有关外,还与足部胼胝的形成有很大的关系。足底胼胝的存在增加了足底压力,胼胝下的正常组织由于受到过度持续的挤压而极易发生病变产生溃疡,严重时溃疡可并发感染,甚至导致截肢。溃疡表面的胼胝质地坚硬、与周边组织紧密粘边,难以去 相似文献
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目的:评价下肢动脉成形术联合局部动脉化疗灌注在糖尿病足合并足部溃疡及感染治疗中的疗效。方法:选择糖尿病足足部溃疡并感染患者19例,下肢动脉成形术后,局部留置导管7~15 d,持续灌注抗感染、溶栓药物。结果:17例患者局部感染病灶控制,溃疡瘢痕愈合,治愈率达89.4%。结论:下肢动脉成形术联合局部动脉药物灌注治疗对糖尿病足合并溃疡及感染的患者具有较好的疗效。 相似文献
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<正> 在美国,绝大多数的足底溃疡是继发于糖尿病的神经并发症。其主要原因是因为足底受压过度和失去保护性感觉。传统的观点认为糖尿病的足底溃疡是因循环障碍引起,最近的研究对此持有异议。这种无痛性溃疡常经久不愈。为利用制动方法减少病变足的压力和重新分配足底部压力可促进伤口的愈合。减少足底压力的方法,可使糖尿病足底溃疡象其它周围神经病变患者的足底溃疡一样痊愈。然而,局部供血不足在一定程度下延缓溃疡的愈合。 相似文献
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Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location 总被引:3,自引:0,他引:3
This study investigated healing rates of chronic diabetic neuropathic foot ulcerations located on the plantar surface of the forefoot (n = 30) versus those located on other parts of the foot (n = 25). Each type of ulceration was treated with total contact casting. Ulcerations in the first group were located on the metatarsal heads and toes, while ulcerations in the second group were located on the dorsum of the foot, heel, plantar arch, ankle, medial aspect of foot, and toe or transmetatarsal amputation sites. Successfully healed diabetic neuropathic foot ulcerations treated with total contact casting were rated according to patient age, ethnic origin, sex, patient weight, ulcer size, ulcer location, duration of ulcer prior to casting, and ulcer grade. Analysis of variance and posthoc analyses demonstrated that (1) total contact casting was a highly effective method of treatment regardless of ulcer location (forefoot ulcer healing time mean = 30.6 days; nonforefoot ulcer healing time mean = 42.1 days) and (2) forefoot ulcerations healed significantly faster than ulcerations located on other parts of the foot. Complex correlational relationships were explored in this study, and multiple regression equations were developed for each location grouping. 相似文献
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BackgroundMechanical stress is important in causing and healing plantar diabetic foot ulcers, but almost always studied as peak pressure only. Measuring cumulative plantar tissue stress combines plantar pressure and ambulatory activity, and better defines the load on ulcers. Our aim was to explore differences in cumulative plantar tissue stress between people with healing and non-healing plantar diabetic foot ulcers.MethodsWe analyzed a subgroup of 31 patients from a randomized clinical trial, treated with a removable offloading device for their plantar diabetic forefoot ulcer. We measured in-device dynamic plantar pressure and daily stride count to calculate cumulative plantar tissue stress at the ulcer location and associated this with ulcer healing and ulcer surface area reduction at four weeks (Student's t and chi-square test for significance, Cohen's d for effect size).FindingsIn 12 weeks, 68% (n = 21) of the ulcers healed and 32% (n = 10) did not. No statistically significant differences were found for cumulative plantar tissue stress, plantar pressure or ambulatory activity between people with healed and not-healed ulcers. Cumulative plantar tissue stress was 25% lower for people with healed ulcers (155 vs. 207 MPa·s/day; P = 0.71; Effect size: d = 0.29). Post-hoc analyses in the 27 patients who self-reported to be adherent to wearing the device showed that cumulative plantar tissue stress was 49% lower for those who reached ≥75% ulcer surface area reduction at four weeks (140 vs. 275 MPa·s/day; P = 0.09; d = 0.76); smaller differences and effect sizes were found for peak pressure (24%), peak pressure-time integral (30%) and ambulatory activity (26%); (P-value range: 0.14–0.97; Cohen's d range: 0.14–0.70).InterpretationMeasuring cumulative plantar tissue stress may provide insight beyond that obtained from plantar pressure or ambulatory activity alone, with regard to diabetic foot ulcer healing using removable offloading devices. These explorative findings provide baseline data for further studies on this relevant topic. 相似文献
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D R Sinacore 《Archives of physical medicine and rehabilitation》1999,80(8):935-940
OBJECTIVE: To compare the healing time of neuropathic plantar ulcers treated by total-contact casting (TCC) in diabetic, immunosuppressed patients after organ transplantation with the healing time of plantar ulcers in control nonimmunosuppressed patients. DESIGN: A case-control design with the control group matched for age, race, sex, body dimensions (height, weight, and body mass index), presence of sensory neuropathy, foot deformity presence and location, and pedal ulcer area and depth. SETTING: An outpatient physical therapy clinic in a regional tertiary-care hospital and academic medical center. PARTICIPANTS: Nine patients with chronic diabetes mellitus and a previous organ transplantation who were currently receiving lifelong immunosuppressive drug therapy were treated for a neuropathic plantar ulcer by means of TCC. Fourteen group-matched control subjects with diabetes mellitus and a plantar ulcer but who had never had an organ transplantation and were not taking immunosuppressive agents were also studied. INTERVENTIONS: TCC with partial weight-bearing using an assistive device until ulcers healed. MAIN OUTCOME MEASURE: Healing time was defined as the number of days in the total-contact cast until the skin completely closed. RESULTS: All diabetic foot ulcers healed with casting. Immunosuppressed/transplanted patients healed in a mean time of 111 +/- 25 days; ulcers of control subjects healed in 47 +/- 18 days (p < .05). All patients returned to ambulation using prescribed therapeutic footwear. None of the patients required a lower extremity amputation throughout the follow-up period. CONCLUSIONS: TCC is a highly effective and rapid method of healing neuropathic pedal ulcers in diabetic immunosuppressed/transplantation patients, although it may take several weeks longer than it would for patients who were not immunocompromised. 相似文献
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The purpose of this case report is to describe a physical therapy approach designed to reduce the mechanical pressure at the site of a diabetic plantar ulcer. The patient was a 69-year-old man with diabetes mellitus for 24 years, insensitive feet, and a right plantar ulcer at the first metatarsal head for 21 months. He had a fixed equinus and rear-foot varus deformity, which seemed to place increased pressure on his forefoot. The patient was treated with total contact casting and showed progressive healing until he refused additional casting. One week later, the ulcer was considerably larger. He consented to resume casting, and the ulcer was completely healed in 85 days from the initial treatment. We provided the patient with extra-depth shoes with rigid rocker-bottom soles and a polyethylene-lined ankle-foot orthosis. The ulcer remained healed at one-week and six-month follow-up visits. The primary cause of diabetic plantar ulcers is often excessive pressure on an insensitive foot, and physical therapists should utilize biomechanical principles to reduce these excessive plantar pressures. 相似文献
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Caravaggi C De Giglio R Pritelli C Sommaria M Dalla Noce S Faglia E Mantero M Clerici G Fratino P Dalla Paola L Mariani G Mingardi R Morabito A 《Diabetes care》2003,26(10):2853-2859
OBJECTIVE: To evaluate the clinical efficacy and safety of HYAFF 11-based autologous dermal and epidermal grafts in the management of diabetic foot ulcers. RESEARCH DESIGN AND METHODS: A total of 79 patients with diabetic dorsal (n = 37) or plantar (n = 42) ulcers were randomized to either the control group with nonadherent paraffin gauze (n = 36) or the treatment group with autologous tissue-engineered grafts (n = 43). Weekly assessment, aggressive debridement, wound infection control, and adequate pressure relief (fiberglass off-loading cast for plantar ulcers) were provided in both groups. Complete wound healing was assessed within 11 weeks. Safety was monitored by adverse events. RESULTS: Complete ulcer healing was achieved in 65.3% of the treatment group and 49.6% of the control group (P = 0.191). The Kaplan-Meier mean time to closure was 57 and 77 days, respectively, for the treatment versus control groups. Plantar foot ulcer healing was 55% and 50% in the treatment and control groups, respectively. Dorsal foot ulcer healing was significantly different, with 67% in the treatment group and 31% in the control group (P = 0.049). The mean healing time in the dorsal treatment group was 63 days, and the odds ratio for dorsal ulcer healing compared with the control group was 4.44 (P = 0.037). Adverse events were equally distributed between the two groups, and none were related to the treatments. CONCLUSIONS: The autologous tissue-engineered treatment exhibited improved healing in dorsal ulcers when compared with the current standard dressing. For plantar ulcers, the off-loading cast was presumably paramount and masked or nullified the effects of the autologous wound treatment. This treatment, however, may be useful in patients for whom the total off-loading cast is not recommended and only a less effective off-loading device can be applied. 相似文献
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OBJECTIVE: To assess the ability of the 4-week healing rate to predict complete healing over a 12-week period in a large prospective multicenter trial of diabetic patients with foot ulceration. RESEARCH DESIGN AND METHODS: We examined the change in ulcer area over a 4-week period as a predictor of wound healing within 12 weeks in patients who were seen weekly in a prospective, randomized controlled trial. RESULTS: Wound area measurements at baseline and after 4 weeks were performed in 203 patients. The midpoint between the percentage area reduction from baseline at 4 weeks in patients healed versus those not healed at 12 weeks was found to be 53%. Subjects with a reduction in ulcer area greater than the 4-week median had a 12-week healing rate of 58%, whereas those with reduction in ulcer area less than the 4-week median had a healing rate of only 9% (P < 0.01). The absolute change in ulcer area at 4 weeks was significantly greater in healers versus nonhealers (1.5 vs. 0.8 cm(2), P < 0.02). The percent change in wound area at 4 weeks in those who healed was 82% (95% CI 70-94), whereas in those who failed to heal, the percent change in wound area was 25% (15-35; P < 0.001). CONCLUSIONS: The percent change in foot ulcer area after 4 weeks of observation is a robust predictor of healing at 12 weeks. This simple tool may serve as a pivotal clinical decision point in the care of diabetic foot ulcers for early identification of patients who may not respond to standard care and may need additional treatment. 相似文献
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[目的]探讨糖尿病足的护理方法.[方法]在控制好血糖、感染的前提下,做好局部溃疡的护理、心理护理、健康宣教.[结果]21例糖尿病足除1例截肢外,其余经3周至2个月治疗,均愈合.[结论]应用全身治疗和护理相结合,有效缩短了溃疡愈合时间,减少了截肢的发生,提高了病人的生活质量. 相似文献
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Katz IA Harlan A Miranda-Palma B Prieto-Sanchez L Armstrong DG Bowker JH Mizel MS Boulton AJ 《Diabetes care》2005,28(3):555-559
OBJECTIVE: The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers. RESEARCH DESIGN AND METHODS: In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at =12 weeks, healing rates, complication rates, cast placement/removal times, and costs. RESULTS: The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC. CONCLUSIONS: The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers. 相似文献
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68例糖尿病足的预防与护理 总被引:1,自引:0,他引:1
目的:探讨糖尿病足的预防与护理。方法:在控制好血糖、感染及改善微循环的前提下,做好患者的饮食护理、心理护理、运动护理及健康宣教。结果:68例糖尿病足除3例截(趾)肢外,其余经综合治疗后45例溃疡患者均有明显好转,19例足部疼痛、麻木症状明显改善,1例因经济情况未坚持治疗,自动出院。结论:应用综合治疗和护理相结合,减轻了糖尿病足患者的临床症状,缩短了溃疡愈合的时间,有效减少了截肢的发生。 相似文献