Clinical efficacy of the first metatarsophalangeal joint arthroplasty as a curative procedure for hallux interphalangeal joint woundsin patients with diabetes

被引:73
作者
Armstrong, DG
Lavery, LA
Vazquez, JR
Short, B
Kimbriel, HR
Nixon, BP
Boulton, AJM
机构
[1] So Arizona Vet Affairs Med Ctr, Dept Surg, Podiatry Sect, Tucson, AZ USA
[2] Texas A&M Hlth Sci Ctr, Scott & White Mem Hosp, Dept Surg, Temple, TX USA
[3] Univ Miami, Diabet Res Inst, Coral Gables, FL 33124 USA
[4] Manchester Royal Infirm, Dept Med, Manchester M13 9WL, Lancs, England
关键词
D O I
10.2337/diacare.26.12.3284
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - To evaluate the safety and efficacy of first metatarsophalangeal joint arthroplasty compared with standard, nonsurgical management of wounds at the plantar hallux interphalangeal joint in patients with diabetes. RESEARCH DESIGN AND METHODS - We evaluated 41 patients with ulcers classified as University of Texas Grade 1A or 2A at the plantar aspect of the first metatarsophalangeal joint using a case-control model. Case subjects were patients treated with resectional arthroplasty and control subjects received standard nonsurgical care. Both groups received standard off-loading and wound care. Outcomes included time to heating, reulceration, infection, and amputation. RESULTS - The surgery group healed significantly faster than patients in the standard therapy group (standard 67.1 +/- 17.1 versus surgery 24.2 +/- 9.9 days, P = 0.0001), and they had fewer recurrent ulcers (Standard 35.0 versus surgery 4.8%, P = 0.02, odds ratio 7.6, 95% CI 1.1-261.7) Both groups had similar rates of infection (standard 38.1 versus surgery 40.0%, P = 0.9) and amputation (standard 10.0 versus surgery 4.8%, P = 0.5). CONCLUSIONS - Results suggest that resectional arthroplasty is a safe and effective procedure to treat wounds of the plantar hallux compared with nonsurgical therapy.
引用
收藏
页码:3284 / 3287
页数:4
相关论文
共 42 条
[1]   Validation of a diabetic wound classification system - The contribution of depth, infection, and ischemia to risk of amputation [J].
Armstrong, DG ;
Lavery, LA ;
Harkless, LB .
DIABETES CARE, 1998, 21 (05) :855-859
[2]   Classifying diabetic foot surgery: toward a rational definition [J].
Armstrong, DG ;
Frykberg, RG .
DIABETIC MEDICINE, 2003, 20 (04) :329-331
[3]  
Armstrong DG, 1998, J REHABIL RES DEV, V35, P1
[4]   Technique for fabrication of an "instant total-contact cast" for treatment of neuropathic diabetic foot ulcers [J].
Armstrong, DG ;
Short, B ;
Espensen, EH ;
Abu-Rumman, PL ;
Nixon, BP ;
Boulton, AJM .
JOURNAL OF THE AMERICAN PODIATRIC MEDICAL ASSOCIATION, 2002, 92 (07) :405-408
[5]   Activity patterns of patients with diabetic foot ulceration - Patients with active ulceration may not adhere to a standard pressure off-loading regimen [J].
Armstrong, DG ;
Lavery, LA ;
Kimbriel, HR ;
Nixon, BP ;
Boulton, AJM .
DIABETES CARE, 2003, 26 (09) :2595-2597
[6]  
BIRKE J A, 1988, Journal of Orthopaedic and Sports Physical Therapy, V10, P172
[7]   PREDICTING AMPUTATION IN SEVERE ISCHEMIA - THE VALUE OF TRANS-CUTANEOUS PO2 MEASUREMENT [J].
BONGARD, O ;
KRAHENBUHL, B .
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 1988, 70 (03) :465-467
[8]  
BRODSKY JW, 1999, SURG FOOT ANKLE, V2, P920
[9]  
COHEN M, 1991, Journal of Foot Surgery, V30, P29
[10]   A PREVENTIVE METATARSAL OSTEOTOMY FOR HEALING PRE-ULCERS IN AMERICAN-INDIAN DIABETICS [J].
DANNELS, EG .
JOURNAL OF THE AMERICAN PODIATRIC MEDICAL ASSOCIATION, 1986, 76 (01) :33-37