糖尿病足最新治疗进展

糖尿病足(diabetic foot,DF)是糖尿病晚期严重并发症之一。其发病率逐年增高,致残、致死率高,发病机制复杂,主要因长期高血糖状态导致的足部神经病变引起皮肤感觉障碍、足部保护性功能缺失,微循环障碍引起局部缺血缺氧,在其他因素如外伤、感染、吸烟、高血压、高血脂、营养状况差等的作用下发生。DF的治疗是医学界难题之一,目前主要治疗方法有足部预防、内科综合治疗如控制血糖、改善循环、控制感染、调节全身情况,辅助措施如清创术、高压氧、负压封闭引流技术等,针对血管病变的动脉旁路移植术、动脉球囊扩张术、支架植入术以及生物技术等,但是这些方法都无法真正有效改善微循环增加足部血运及促进周围神经功能恢复,因此足部溃疡、感染仍无法愈合甚至复发。胫骨横向骨搬移技术,是Ilizarov技术在组织牵拉再生(血管、神经再生)领域的临床应用,针对DF主要发病原因微循环障碍和神经功能障碍进行治疗,可以激活人体的再生系统,明显促进微循环的再生,改善周围神经功能,控制局部感染、促进溃疡愈合并降低复发可能性,是微血管领域的一项重大突破,为DF的治疗带来了新的希望。现就糖尿病足治疗现状作一总结,以期帮助临床医师制定更加合理有效的治疗方案。 

The latest treatment progress of diabetic foot

Diabetic foot (DF) is one of the serious complications of the late diabetes. The incidence rate of DF increased year by year, and it has high disability and mortality rate with complex pathogenesis mainly involving long-term hyperglycemia leading to foot neuropathy which causes the deficiency of foot protective function and microcirculatory disturbance which is induced by ischemia and hypoxia. Other factors such as trauma, infection, smoking, hypertension, and hyperlipidemia also have important influence. The therapy of DF is one of the medical challenges. The main treatment methods include foot prevention, medical comprehensive treatment, such as blood glucose control, infection control, the nerves, improvement of circulation, and auxiliary measures which include debridement, hyperbaric oxygen and closed negative pressure drainage technology, and artery bypass grafting, artery balloon dilatation, stent implantation as well as biotechnology targeting at the vascular lesions. However, none of these methods could effectively improve microcirculation, increase foot blood supply and promote peripheral nerve functional recovery. The foot ulcers and infections still unhealed and even relapsed again. Transverse tibial bone transport technology, which is one of clinical application of Ilizarov technology in tissue regeneration(blood vessels and nerve regeneration areas), can activate the regeneration system of the human body, promote microcirculation regeneration, improve peripheral nerve function, control of local infection, and promote ulcer healing to reduce the possibility of recurrence. It is a major breakthrough in the field of micro blood vessels, and brings new hope for the treatment of diabetic foot. The present situation of diabetic foot treatment is summarized, with a view to developing a more reasonable and effective treatment plan for clinicians.