医学
外科
糖尿病足
关节置换术
切除术
保守治疗
前瞻性队列研究
清创术(牙科)
荟萃分析
保守管理
糖尿病
内科学
内分泌学
作者
Kaissar Yammine,Chahine Assi
标识
DOI:10.1053/j.jfas.2020.04.025
摘要
The standard medical care (SC) of non-infected diabetic foot ulcers (DFUs) has been reported to yield varying rates of wound healing with high recurrence rate in non-infected wounds. Conservative surgery has been advanced as an alternative to SC in treating resistant non-complicated and complicated DFUs. Studies reporting resection arthroplasty (RA) of the first metatarsal head stated high healing rates with less recurrence. The aim of this meta-analysis is to quantitatively assess the efficacy of the RA procedure. Based on 9 included studies (3 case-control and 6 case-series) with 225 patients (244 feet, 244 hallucal plantar ulcers) and a mean follow-up period was of 22.8 ±13.3 months, the weighted estimates of comparative studies (RA vs. SC) were as follows: healing rate (100% vs. 79.9%, p = .0001), time to heal (3.3 ±0.28 vs. 8.4 ±1.5 weeks, p = .002), recurrence rate (5.7% vs. 25.4%, p = .001) and transfer rate (4.5% vs. 1.4%, p = .1). Similar values were found when analyzing case-series of non-infected and infected wounds treated with RA. Based on the available evidence, resection arthroplasty of the first ray is to be considered an effective conservative surgery in treating resistant or complicated hallucal neuropathic ulcers. Further prospective controlled trials are warranted to validate the review findings.
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