中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (14): 2291-2296.doi: 10.12307/2023.483

• 组织构建学术探讨 tissue construction academic discussion • 上一篇    

ANTI∙DF原则对糖尿病足防治的指导作用

李  锐，欧小兰，刘  军，田  恒，瞿文瑞，朱  哲，张振宇，刘倩倩，郭文来   

  1. 吉林大学第二医院手外科，吉林省长春市  130022
  • 收稿日期:2022-08-12 接受日期:2022-08-25 出版日期:2023-05-18 发布日期:2022-09-30
  • 通讯作者: 李锐，吉林大学第二医院手外科，吉林省长春市 130022
  • 作者简介:李锐，博士，吉林大学第二医院手外科，吉林省长春市 130022

Introduction to the ANTI∙DF principle for diabetic foot prevention and treatment

Li Rui, Ou Xiaolan, Liu Jun, Tian Heng, Qu Wenrui, Zhu Zhe, Zhang Zhenyu, Liu Qianqian, Guo Wenlai   

  1. Department of Hand Surgery, Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
  • Received:2022-08-12 Accepted:2022-08-25 Online:2023-05-18 Published:2022-09-30
  • Contact: Li Rui, Department of Hand Surgery, Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
  • About author:Li Rui, MD, Department of Hand Surgery, Second Hospital of Jilin University, Changchun 130022, Jilin Province, China

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摘要：

文题释义：
ANTI∙DF原则：临床上涉及糖尿病足的因素有10个：Artery(动脉)、Nerve(神经)、Tissue nonviable(坏死组织)、Infection or inflammation(感染或炎症)、Muscle(肌肉)、Osteoarticular lesion(骨关节病损)、Subcutaneous Tissue(皮下组织)、Tendon(肌腱)、Deformity(畸形)、Foot ulcer(足部溃疡)，此10个因素将分别用其英文首字母代表，可归纳为ANTI∙MOST∙DF原则，适用于大部分糖尿病足的防治和治疗。因为D(畸形)包括MOST4个解剖结构的形态改变，所以MOST这4个因素可以被简化掉，简称ANTI∙DF原则。
糖尿病足：指与下肢远端神经异常和不同程度的周围血管病变相关的足部(踝关节及踝关节以下)感染、溃疡和(或)深层组织破坏。

背景：糖尿病足存在较严重的致死率及致残率，因此有必要对糖尿病足的预防和治疗进行总结和认识，为糖尿病足预防及治疗提供一些思路和方向。
目的：文章通过对糖尿病足病因、预防、治疗等因素进行总结，提出ANTI∙DF原则指导糖尿病足防治的学术观点探讨。
方法：通过ANTI∙DF原则概括糖尿病导致畸形、畸形导致足部溃疡、治疗和预防等几个方面，参考国际与中国相关指南及文献，按入组标准在中英文数据库中筛选出73篇文献，以此总结提出糖尿病足的防治原则。
结果与结论：①涉及糖尿病足创面形成的原因和造成创面难愈合的因素有10个：动脉(Artery)、神经(Nerve)、坏死组织(Tissue nonviable)、感染或炎症(Infection or inflammation)、肌肉(Muscle)、骨关节病损(Osteoarticular lesion)、皮下组织(Subcutaneous Tissue)、肌腱(Tendon)、畸形(Deformity)及足部溃疡(Foot ulcer)。②下文中此10个因素将分别用其大写英文首字母代表，可归纳为ANTI∙MOST∙DF原则。因为畸形(D)包括MOST4个解剖结构的形态改变，所以MOST这4个因素可以被简化掉，简称ANTI∙DF原则。③从糖尿病足病因学方面考虑，ANTI DF原则这6个因素中，畸形(D，包括MOST的4个解剖结构的形态改变)是“真凶”，神经(N)病变是“元凶”，动脉(A)缺血通常是“帮凶”，组织(T)坏死、感染(I)和足部溃疡(F)只是“外在表现”。④从糖尿病足防治学方面来说，缓解畸形(D)造成的压力、改善神经(N)保护功能、恢复动脉(A)供血是预防及治疗坏死组织、感染或炎症、足部溃疡(TIF)的前提；清创坏死组织(T)是控制感染(I)的前提；清创坏死组织(T)和控制感染(I)是闭合足部溃疡(F)的前提。⑤文章是该团队提出的学术观点讨论，希望ANTI DF原则为临床工作者在糖尿病足防治的临床实践过程中提供治疗依据，以期使糖尿病足患者的患足获得迅速愈合，并预防复发。

https://orcid.org/0000-0001-7857-9735 (李锐) 

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 糖尿病足, 糖尿病周围神经病变, 糖尿病周围血管病变, 足部畸形, 足底高压, 足部溃疡, 感染, 治疗

Abstract: BACKGROUND: Diabetic foot has serious mortality and disability rate. Therefore, it is necessary to summarize and understand how to prevent and treat diabetic foot, thereby providing some ideas and directions for the prevention and treatment of diabetic foot.
OBJECTIVE: To summarize the etiology, prevention measures, and treatments of diabetic foot, thus proposing the academic viewpoints of the ANTI∙DF principle to guide the prevention and treatment of diabetic foot.
METHODS: As per the ANTI∙DF principle, we summarized several aspects such as deformity caused by diabetes, foot ulcer caused by deformity, treatment and prevention of diabetic foot. With reference to relevant international and Chinese guidelines and literature, 73 articles were selected from the Chinese and English databases according to the inclusion criteria and were used to summarize the principles of diabetic foot prevention and treatment.
RESULTS AND CONCLUSION: There are 10 factors related to the formation of diabetic foot wounds and refractory wounds: artery, nerve, tissue nonviable, infection or inflammation, muscle, osteoarticular lesion, subcutaneous tissue, tendon, deformity, and foot ulcer. The 10 factors hereinafter will be represented by their initials, which can be summarized as the ANTI∙MOST∙DF principle. Deformity (D) includes the morphological changes of the four anatomical structures – MOST. Therefore, these four factors, MOST, can be simplified and the principle is referred to as the ANTI∙DF principles. Etiologically, among the six factors of the ANTI∙DF principle, deformity (D, including the morphological changes of the four anatomical structures of MOST) is the “real culprit,” and neurological (N) lesions are the “crime culprit.” Arterial (A) ischemia often acts as the “accomplice.” Tissue (T) necrosis, infection (I), and foot ulcers (F) are only “external manifestations.” From the perspective of diabetic foot prevention and treatment, relieving the pressure caused by deformity (D), improving neuroprotection (N) function, and restoring arterial (A) blood supply are the premises for the prevention and treatment of necrotic tissue, infection or inflammation, and foot ulcers (TIF). Debridement of necrotic tissue (T) is the prerequisite for infection (I) control; debridement of necrotic tissue (T) and infection (I) control are the prerequisite for closure of foot ulcers (F). The ANTI∙DF principle is expected to provide clinical practitioners with a basis for the clinical prevention and treatment of diabetic foot, to achieve rapid wound healing and prevent recurrence in patients with diabetic foot.

Key words: diabetic foot, diabetic peripheral neuropathy, diabetic peripheral vascular disease, foot deformities, plantar high pressure, foot ulcer, infection, treatment

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