Značaj statičkog i dinmičkog modela merenja plantarnog pritiska u dijagnostici dijabetesnog stopala
The significance of the static and dynamic model of plantar pressure measurement in the diagnosis of diabetic foot
Докторанд
Bubanja, DraganaМентор
Jovanović, Zorica D.Чланови комисије
Živančević-Simonović, SnežanaĐukić, Aleksandar
Filipović, Nenad
Jotić, Aleksandra
Метаподаци
Приказ свих података о дисертацијиСажетак
Uvod: Dijabetesno stopalo je hronična komplikacija dijabetes melitusa (DM) koja
nastaje usled strukturalnih i funkcionalnih poremećaja stopala. Ono predstavljaznačajan problem kod obolelih od dijabetes melitusa zbog sklonosti ka nastanku
ulceracija, infekcija ili oštećenja mekih tkiva stopala, a pogađa skoro polovinu
obolelih kod kojih bolest traje duže od 10 godina kao i one obolele koje imaju
dijabetesnu perifernu neuropatiju. Dijabetes melitus danas u svetu dobija razmere
pandemije i uzrok je 8 od 10 netraumatskih amputacija. Mortalitet nakon amputacije
kreće se od 39% do 80% za 5 godina, što je lošije nego za većinu malignih bolesti.
Ovom studijom je izvršeno poređenje dijagnostičkih test karakteristika statičkog i
dinamičkog merenja plantarnih pritisaka u odnosu na test karakteristike
monofilamentom kod pacijenata sa dijabetes melitusom i dijabetesnim stopalom.
Metodologija:Sprovedena je opservaciona studija preseka između pacijenata sa
dijabetesnim stopalom i kontrolne... grupe zdravih dobrovoljaca pregledanih u KC
Kragujevac, u periodu od juna 2014. do decembra 2014.godine. Studija je obuhvatila 130
ispitanika podeljenih u dve grupe, i urađeno je 1560 merenja pedografom. Sva merenja
obavljena su u toku jedne posete i pored anamneze i antropometrijskih merenja, vitalnih
znakova, kliničkog neuropatskog skora (KNS) 1-4, testa monofilamentom (10g) u 10
tačaka, test vibracionog senzibiliteta (zvučna viljuška 128Nѕ), urađena su i merenja na
pedografu ”FOOTWORK PRO”- platformi. Mereni su pritisci i raspodele sile tokom
stajanja i hoda. Određen je stepen korelacije između mesta maksimalnih i srednjih
pritisaka oba merenja i rezultata testa monofilamentom sa kliničkim promenama na
stopalima uočenim pri kliničkom pregledu i zabeleženih na skicama i fotografijama.
Rezultati:Statičko i dinamičko merenje plantarnih pritisaka zajedno sa testom
monofilamentom, u odnosu samo na test monofilamentom, omogućava značajno bolju ranu
dijagnostiku dijabetesnog stopala. Od sva tri navedena testa dinamički model merenja je
bio u najboljoj korelaciji sa kliničkim nalazom i to u 95.54%. Ispitivanjem svih
parametara dinamičkog modela merenja u projekciji III MT kosti za oba stopala, najveću
površinu ispod krive ima integral pritisak/vreme ( AUC 0.684, SE 0,035 CI
0.614<0.751), sa visokom statističkom značajnošću između grupa (p<0.001). Parametri
koji su u funkciji vremena izdvojili su se kao najznačajniji u predikciji mesta
nastanka ulkusa i time ukazali da je dužina trajanja pritiska i njegovo ciklično
ponavljanje značajnije od same jačine pritiska u nastanku ulkusa.Zaključak: U dijagnostici dijabetesnog stopala određivanje plantarnog pritiska na
pedografu, posebno dinamičkim modelom merenja pokazalo se kao dobar instrument.
Prednost parametra integrala pritisak/vreme i drugih parametara koji su u funkciji
vremena u odnosu na parametre statičkog modela merenja pokazalo je da je za nastanak
predilekcionog mesta ulkusa od same jačine dejstva sila značajnije vreme trajanja i
ciklično ponavljanje pritiska. Ovo saznanje otvara nove mogućnosti za dijagnostiku i
prevenciju nastanka ulkusa kod dijabetesnog stopala.
Introduction: The diabetic foot is a chronic complication of diabetes mellitus (DM) due to
structural and functional foot disorders. It is a major problem in people suffering from
diabetes mellitus with a tendency for ulcers, infection or damage to the deep soft tissues of
the foot, and occurs in almost 50% of patients with diabetes who suffer for longer than 10
years and in patients with diabetic peripheral neuropathy, which is the most common
chronic complication in type 2 diabetes. Diabetes mellitus today is pandemic, and is
responsible for 8 out of 10 non-traumatic amputations. Mortality after amputation ranges
from 39% to 80% in 5 years, which is worse than in most malignancies. This study
compares the diagnostic tests of the characteristics of static and dynamic measurements of
plantar pressures in relation to the monofilament test in patients with diabetes mellitus and
diabetic foot.
Methodology: An observational study of intersection between patients with diabetes an...d a
control group of healthy volunteers was performed in KC Kragujevac in the period from
June 2014. to December 2014. The study included 130 respondents divided into two groups,
and 1560 measurements were made on the pedograph. All measurements were made
during one visit, and in addition to anamnesis and anthropometric measurements, vitalsigns, clinical neuropathic score (KNS) 1-4, 10-point test with 10-point test, vibration
sensitivity test (sound fork 128N), and measurements on the pedograph ""FOOTWORK
PRO" - platform. The pressure and distribution of forces are measured during standing
and walking. The degree of correlation between the maximum and the middle pressure
points of both measurements and the results of the monofilament test with clinical changes
on the feet observed in the clinical examination and recorded in sketches and photographs.
Results: The static and dynamic measurement of plantar pressures together with the
monofilament test, compared only to the monofilament test, provides significantly better
early diagnosis of the diabetic foot. Of all three of these tests, the dynamic measurement
model was in the best correlation with the clinical finding (95.54%). By examining all
parameters of the dynamic measurement model in the III MT bone projection for both
feet, the largest area under the curve has an integral pressure / time (AUC 0.684, SE 0.035
CI 0.614 <0.751), with high statistical significance between groups (p <0.001).The time
function parameters were singled out as the most significant in the prediction of the
location of the ulcer,
indicating that the duration of pressure and its cyclical repetition are more important than
the severity of pressure in the appearance of the ulcer.
Conclusion: In the diagnosis of diabetic foot, the determination of plantar pressure on the
pedograph, especially the dynamic model of measurement, has proven to be a good
instrument. The advantage of the pressure / time integral parameter and other parameters
that are in function of time in relation to the parameters of the static model of
measurement has shown that for the formation of the predilection point of the ulcer,
duration and a cyclic repetition of pressure is a more significant than the force itself. This
finding opens a new possibilities in diagnosing and prevention of ulcer in the diabetic foot.