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北京大學(xué)第一醫(yī)院醫(yī)學(xué)影像科容蓉糖尿病足DIABETIC
FOOT1糖尿?。―iabetes
Mellitus
)2Diabetes
mellitus
is
a
rather
verycommon
systemic
diseaseIncidence
of
diabetes
in
the
world
in2000
was
171,000,000Projected
incidence
in
2030
is
366,000,00020%
of
these
patients
will
behospitalized
at
least
once
in
their
lifetime
with
foot
problems糖尿病足的定義3DefinitionInfection,
ulceration
or
destruction
of
deeptissues
associated
with
neurologicalabnormalities
&
various
degrees
of
peripheralvascular
diseases
in
the
lower
limb(based
on
WHOdefinition)流行病學(xué)440%
-
60%
of
allnon
traumatic
lower
limbamputation85%
of
diabetic
related
foot
amputationare
preceded
by
foot
ulcer4
out
of
5
ulcer
in
diabeticsareprecipitated
by
trauma4%
-10%
is
the
prevalence
of
foot
ulcer
indiabetics病生理機(jī)制5NeuropathyIschemiaNeuro
–ischemicInfectionNeuropathy6One
of
the
triad
of
thepathologicalconditions
characteristic
of
this
disease(neuropathy,
nephropathy
andretinopathy)Diabetic
neuropathy
is
the
majorcontributor
to
ulcer
formationandsubsequent
osteomyelitisPathogenesisChanges
in
thevasa
nervosaMetabolic
disorders
with
release
of
nerve toxic
substanceNeuropathy7Sensory
neuropathyRepetitive
damage
and
trauma
without
protectivereflexesMotor
neuropathyStrong
plantar
flexors,
and
weak
intrinsic
musclesThese
imbalances
lead
to
altered
weightdistribution
and
foot
pressures,
causing
abnormalpressure
points,
shoe
wear,
and
skin
breakdown.Autonomic
neuropathyDeficient
sweat
production
causes
thick,
dry
skinand
callus
formation
in
areas
of
pressure.
Fissuresdevelop
and
allow
entry
of
microorganisms.
Ulcerand
sinus
tract
formation
begins.Sensory
neuropathy8Sensory
loss
of
superficial
anddeepsensation
is
the
most
important
part
ofsensory
affectionPatients
are
unaware
of
trauma
to
the
footand
usually
result
in
pressure
sores
overweight
bearing
points
of
thefootMotor
neuropathyWasting
of
small
muscles
of
the
foot
andfoot
deformities
(claw
foot)9Autonomic
neuropathy10Dryness
of
the
skin
and
loss
of
sweat
andoil
secretion
which
leads
to
excessivecallus
formation
and
skin
cracksLoss
of
neurogenic
component
ofinflammatory
response
which
leadstoplunting
of
inflammatory
response
andless
severe
signs
of
a
severe
infectionsNeuropathicarthropathy11Joints
can
be
affected
by
neuropathyresulting
in
the
so
called
Charcot
footIt
is
relatively
painless
progressivedegenerative
arthropathy
of
single
ormultiple
jointsCaused
by
loss
of
proprioceptive
and
painsensationLeads
to
foot
deformity
and
abnormalpressure
points12Ischemia13Diabetes
mellitus
is
an
independent
risk
factorfor
atherosclerosis
(coronary,
cerebral
andperipheral)Usually
atherosclerosis
affects
crural
vessel(anterior
tibial,
posterior
tibial
and
peroneal)
withsparing
of
aortoiliac
and
femoral
segmentsAnkle
vessels
runoff
are
usually
patent
(posteriortibial
and
dorsalis
pedis)
,but
they
may
lead
to
adiseased
foot
arches
(distal
vessel
disease)Medial
calcification
affects
all
vessels
but
thevessels
remain
patent
in
spite
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