Clinical value analysis of limited debridement for the treatment of incomplete gangrenous diabetic foot osteomyelitis / 中华骨科杂志

ABSTRACT

Objective To investigate the clinical value of limited debridement in treating diabetic foot osteomyelitis with incomplete foot gangrene.Methods Retrospective analysis of traditional surgery (complete removal of diseased bone and soft tissue) and limited debridement (limited removal of diseased bone and soft tissue) in patients with incomplete foot gangrenuria foot osteomyelitis from February 2015 to March 2017,There were 38 cases in the traditional operation group and 76 cases in the limited debridement group.Between the two groups,the sex ratio (20/18 vs 41/35),age (64.90±8.40 vs 68.1±8.10),Wagner 3/4 grading ratio (12/26 vs 26/50),the ratio of nerve ulcers/ischemic neurotic ulcers (13/25 vs 24/52),the ulceration ratio of forefoot/middle foot±hind foot (33/5 vs 68/8),arterial ABI (0.71±0.39 vs 0.67±0.33),and lower extremity arterioplasty ratio (52.63％ vs 59.21％),combined with hypertension (78.95％ vs 77.63％),coronary heart disease (71.05％ vs 69.74％),cardiac insufficiency (10.53％ vs 9.21％),renal failure rate (21.05％ vs 22.37％),incidence of hypoproteinemia (10.53％ vs 10.53％),anaemia (15.79％ vs 19.74％) and drug resistance of drug resistant bacteria (26.32 vs 23.68％) had no statistical difference.All the patients received antibiotic after surgery.The incidence of antibiotic related complications,the rate of amputation on the ankle,the average length of hospitalization,the average healing time of the ulcer/wound,the rate of readmission in one year,the rate of recurrent ulcer,the rate of new ulceration,the rate of ulceration and the death rate were collected to evaluate the clinical effects.Results The duration of antibiotic use in the traditional operation group (25.2±12.3 d) and the average hospitalization time (16.9±7.6 d).The average healing time of ulcer/wound (121.6 ±23.7 d) was shorter than that of limited debridement group (32.5± 16.8 d,24.7± 12.5 d,153.2±27.8 d).The amputation rate (1.32％),re-admission rate (1.32％),ulcer recurrence rate (2.63％) and ulcer recurrence rate (1.32％) in the limited debridement group were significantly lower than those in the traditional operation group (10.53％,31.58％,21.05％,28.95％).There was no significant difference in the incidence of antibiotic-related complications and all-cause mortality between the two groups.Conclusion Conservative surgery for diabetic foot osteomyelitis of incomplete foot gangrene is scientific and reasonable,and the quality of life of patients can be improved.The clinical benefit is obvious.It is worth of clinical promotion.