压缩性神经外科手术与低糖尿病脚率和高风险偏见相关:系统性审查和元分析
Milton Louca1,2,3,4,5, Charles Meares2, Joseph R Dusseldorp2,5
1From the University of New South Wales.
Plastic and reconstructive surgery
|September 12, 2024
概括
解压神经手术 (DNS) 显示糖尿病足 (DFU) 发病率较低 (1%新发,5%复发). 然而,目前的证据质量不佳,需要进一步研究DFU管理建议.
科学领域:
- 糖尿病学 糖尿病学
- 神经外科 神经外科
- 基于证据的医学 基于证据的医学
背景情况:
- 糖尿病感觉运动性多神经病变 (DSPN) 影响50%的糖尿病患者,高达70%的人患有糖尿病足 (DFU).
- 在患有DSPN的人中,20%患有DFU,这突显出一个重大的临床挑战.
- 建议进行解压神经手术 (DNS),以改善DSPN和DFU的结果,但缺乏DFU发病率数据.
研究的目的:
- 系统地审查和分析糖尿病足 (DFU) 在解压神经手术 (DNS) 后的发病率.
- 测试DNS导致较低的聚合DFU发生率与全球发生率相比的假设.
主要方法:
- 在2023年7月之前,对6个数据库进行了系统的文献搜索,以对成人DM患者的DNS进行临床研究.
- 包括的研究要求至少3个月的随访,并报告了新的或复发的DFU发病率后DNS.
- 使用GRADE和MINORS评估证据质量;对DFU发生率进行了随机效应模型元分析.
主要成果:
- 分析了13项研究,包括2466例新的和540例复发的DFU病例.
- 新发生的DFU的综合发病率为1%,复发的DFU为5%.
- 初级研究显示低水平的证据和偏差的高风险,包括选择偏差,排除了进一步的详细分析.
结论:
- 虽然DNS表明DFU的发病率很低,但由于质量低且偏差很高,目前的证据基础不足以提出建议.
- 建议在未来进行随机对照试验,以严格评估DNS在DFU管理中的有效性.
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