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[ADA2014]神秘的Charcot足
——美国匹兹堡大学医学中心Dane K. Wukich教授访谈
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作者:D.K.Wukich 2014/6/17 13:33:00    加入收藏
内容概要:《国际糖尿病》:感谢您为大家带来精彩的演讲。众所周知,夏科氏足是糖尿病患者致残的主要原因,能否请您与我们分享一下该病治疗方面的最新进展?
  <International Diabetes>: Thank you for your wonderful speech.  As a surgeon, we know that the Charcot foot is a devastating disability of diabetes.  Could you please share with us some treatment or progression in this disease?
  Dr. Wukich : The most important thing about charcot that we need to understand is early diagnosis.  I think most of these patients do not get diagnosed early.  If we can diagnose them early before things develop into deformities, we can prevent foot alterations, we can prevent deformities, we can prevent infections, and we can prevent amputations.  The most important thing is not very sophisticated at all, it is very early diagnosis, and to think of this as a diagnosis.
  《国际糖尿病》:感谢您为大家带来精彩的演讲。众所周知,夏科氏足是糖尿病患者致残的主要原因,能否请您与我们分享一下该病治疗方面的最新进展?
  Wukich教授:夏科氏足最重要的是要早期诊断。我认为,临床实践中很多患者并未能得到及时的早期诊断。如果能在发生畸形前对其实现早期诊断,我们则可以预防足部变形、畸形、感染及截肢。其实夏科氏足诊疗最重要的事情并不复杂,就是需要早期诊断。
  <International Diabetes>:  What are you saying we need to do so we can diagnosis this earlier?
  Dr. Wukich :  If you see a patient with diabetes with neuropathy, they do not have good sensation in their foot and they present with a swollen foot, they may or may not have trauma.  Always keep in your mind that they may have a Charcot foot.  They may have a normal x ray at that point, if somebody comes in like that I will ask that they get offloaded with crutches, a boot, or a cast and I will go to MRI.  A MRI will show bony edema before the x ray changes and you can prevent the deformity.
  《国际糖尿病》:您认为我们需要怎么做才能实现对该病的早期诊断?
  Wukich教授:糖尿病神经病变患者常足部感觉下降,出现脚肿,可能还会伴或不伴有创伤。除此之外,我们还需要牢记,他们还可能会出现夏科氏足,但其X线检查结果可能是正常的。遇到这样的患者,我会要求他们去除拐杖等外界辅助设备,进行MRI检查。MRI检查能在夏科氏足患者出现X线改变前发现骨性水肿,从而使我们能够预防畸形的发生。
 
  <International Diabetes>:  We also know that teamwork is very important for the care of this disease.  In your opinion what aspect do we need to bring to teamwork for the care of this disease?
  Dr. Wukich :  It is absolutely important to have a multidisciplinary approach to this.  If we are a surgeon and you can be an orthopedic surgeon, you can be a podiatrist, you can be a vascular surgeon or plastic surgeon, you still need endocrinologists to help you provide good glycemic control, you need good nursing control.  You need good nurses who know how to manage these patients, you need to have infectious disease doctors incase you get an infection.  You need to have good muscular skeletal imaging so really in the United States there is a saying, there is no I in the word ‘team’ and that is the case.
  《国际糖尿病》:众所周知,团队合作对该病的治疗而言至关重要。在您看来,哪些人员应参与到该病的团队管理中?
  Wukich教授:多学科的团队合作对该病的管理确实至关重要。无论是骨科医生、足科医生、血管外科医生或整形外科医生,都仍然需要内分泌科医生帮助实现良好的血糖控制,需要护士帮助良好的管理这些患者,需要感染科医生帮助确定是否合并感染。此外,鉴于需要对患者进行良好的肌肉骨骼成像,故影像科医生也应被纳入其中。在美国是非常强调团队合作的。
 


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