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中华损伤与修复杂志(电子版) ›› 2023, Vol. 18 ›› Issue (01) : 10 -15. doi: 10.3877/cma.j.issn.1673-9450.2023.01.002

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保肢还是截肢:论重症糖尿病足治疗的临床思维与决策
贾赤宇1,(), 张泽鑫2, 尹斌1   
  1. 1. 421001 衡阳,南华大学附属第一医院烧伤整形与创面修复中心
    2. 361102 厦门大学医学院
  • 收稿日期:2022-12-11 出版日期:2023-02-01
  • 通信作者: 贾赤宇
  • 基金资助:
    福建省自然科学基金(2019J01011); 福建医科大学附属协和医院省级重点实验室开放课(XHZDSYS202004,XHZDSYS202005); 2020年省卫生健康面向农村和城市社区推广适宜技术资助计划(2020TG028); 湖南省卫生健康委科研课题(202104100031); 湖南省临床医疗技术创新引导项目(2020SK51820)

Limb salvage or amputation: on the clinical thinking and decision-making of the treatment of severe diabetic foot

Chiyu Jia1,(), Zexin Zhang2, Bin Yin1   

  1. 1. Center of Burns and Plastic and Wound Repair Surgery, First Affiliated Hospital of University of South China, Hengyang 421001, China
    2. Medical School of Xiamen University, Xiamen 361102, China
  • Received:2022-12-11 Published:2023-02-01
  • Corresponding author: Chiyu Jia
引用本文:

贾赤宇, 张泽鑫, 尹斌. 保肢还是截肢:论重症糖尿病足治疗的临床思维与决策[J]. 中华损伤与修复杂志(电子版), 2023, 18(01): 10-15.

Chiyu Jia, Zexin Zhang, Bin Yin. Limb salvage or amputation: on the clinical thinking and decision-making of the treatment of severe diabetic foot[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(01): 10-15.

近些年来,虽然糖尿病足的基础研究和临床治疗有了较大的进步,但未能取得突破性进展。保肢还是截肢,始终是重症糖尿病足临床思维的困惑和临床治疗决策的难点。虽然保肢依然是目前的主流观点和治疗选择,但截肢并非意味治疗的失败。本文论述了2种观念的优缺点,认为被动性截肢患者往往全身状况较差,常预后不良(死亡/截肢创面不愈),提出对重症糖尿病足患者,应针对病情和肢体功能选择进行有针对性、预判性和主动性的截肢,以期达到迅速控制病情、缩短住院时间和获得较好预后的治疗结局。同时提出应尽早进行2种治疗方案远期疗效的多中心对比性临床研究。

In recent years, although the basic research and clinical treatment of diabetic foot have made great progress, no breakthrough has been made. Limb salvage or amputation is always the perplexity of clinical thinking and the difficulty of clinical treatment decision of severe diabetic foot. Although limb salvage is still the mainstream view and treatment option, amputation does not mean treatment failure. This paper discusses the advantages and disadvantages of the two concepts, arguing that patients with passive amputation often have poor general condition and poor prognosis (death/wound healing of amputation), and proposes that targeted, predictive and proactive amputation should be selected for patients with severe diabetic foot according to the condition and limb function, in order to achieve rapid control of the disease, shorten the length of hospitalization and obtain a better prognosis outcome. At the same time, it is proposes that a multicenter comparative clinical study of the long-term efficacy of the two treatment options should be conducted as soon as possible.

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