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糖尿病足

DiabeticFoot北京大學第一醫院醫學影像科容蓉1糖尿?。―iabetesMellitus)DiabetesmellitusisaratherverycommonsystemicdiseaseIncidenceofdiabetesintheworldin2000was171,000,000Projectedincidencein2030is366,000,00020%ofthesepatientswillbehospitalizedatleastonceintheirlifetimewithfootproblems2糖尿病足的定義DefinitionInfection,ulcerationordestructionofdeeptissuesassociatedwithneurologicalabnormalities&variousdegreesofperipheralvasculardiseasesinthelowerlimb(basedonWHOdefinition)3流行病學40%-60%ofallnontraumaticlowerlimbamputation85%ofdiabeticrelatedfootamputationareprecededbyfootulcer4outof5ulcerindiabeticsareprecipitatedbytrauma4%-10%istheprevalenceoffootulcerindiabetics4病生理機制NeuropathyIschemiaNeuro–ischemicInfection5NeuropathyOneofthetriadofthepathologicalconditionscharacteristicofthisdisease(neuropathy,nephropathyandretinopathy)DiabeticneuropathyisthemajorcontributortoulcerformationandsubsequentosteomyelitisPathogenesisChangesinthevasanervosaMetabolicdisorderswithreleaseofnerve toxicsubstance6NeuropathySensoryneuropathyRepetitivedamageandtraumawithoutprotectivereflexesMotorneuropathyStrongplantarflexors,andweakintrinsicmusclesTheseimbalancesleadtoalteredweightdistributionandfootpressures,causingabnormalpressurepoints,shoewear,andskinbreakdown.AutonomicneuropathyDeficientsweatproductioncausesthick,dryskinandcallusformationinareasofpressure.Fissuresdevelopandallowentryofmicroorganisms.Ulcerandsinustractformationbegins.7Sensoryneuropathy

SensorylossofsuperficialanddeepsensationisthemostimportantpartofsensoryaffectionPatientsareunawareoftraumatothefootandusuallyresultinpressuresoresoverweightbearingpointsofthefoot8Motorneuropathy

Wastingofsmallmusclesofthefootandfootdeformities(clawfoot)9Autonomicneuropathy

DrynessoftheskinandlossofsweatandoilsecretionwhichleadstoexcessivecallusformationandskincracksLossofneurogeniccomponentofinflammatoryresponsewhichleadstopluntingofinflammatoryresponseandlessseveresignsofasevereinfections10NeuropathicarthropathyJointscanbeaffectedbyneuropathyresultinginthesocalledCharcotfootItisrelativelypainlessprogressivedegenerativearthropathyofsingleormultiplejointsCausedbylossofproprioceptiveandpainsensationLeadstofootdeformityandabnormalpressurepoints1112Ischemia

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