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The significance of the static and dynamic model of plantar pressure measurement in the diagnosis of diabetic foot

dc.contributor.advisorJovanović, Zorica D.
dc.contributor.otherŽivančević-Simonović, Snežana
dc.contributor.otherĐukić, Aleksandar
dc.contributor.otherFilipović, Nenad
dc.contributor.otherJotić, Aleksandra
dc.creatorBubanja, Dragana
dc.date.accessioned2019-05-30T12:15:21Z
dc.date.available2019-05-30T12:15:21Z
dc.date.available2020-07-03T15:16:39Z
dc.date.issued2018-10-10
dc.identifier.urihttp://eteze.kg.ac.rs/application/showtheses?thesesId=6674
dc.identifier.urihttp://nardus.mpn.gov.rs/handle/123456789/11127
dc.identifier.urihttps://fedorakg.kg.ac.rs/fedora/get/o:1103/bdef:Content/download
dc.description.abstractUvod: 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.sr
dc.description.abstractIntroduction: 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 and 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.en
dc.formatapplication/pdf
dc.languagesr
dc.publisherУниверзитет у Крагујевцу, Факултет медицинских наукаsr
dc.rightsopenAccessen
dc.sourceУниверзитет у Крагујевцуsr
dc.subjectDijabetesno stopalosr
dc.subjectDiabetic footen
dc.subjectplantar pressureen
dc.subjectmonofilament testen
dc.subject"ROC" procedureen
dc.subjectplantarni pritisaksr
dc.subjecttest monofilamentom „ROC” procedurasr
dc.titleZnačaj statičkog i dinmičkog modela merenja plantarnog pritiska u dijagnostici dijabetesnog stopalasr
dc.title.alternativeThe significance of the static and dynamic model of plantar pressure measurement in the diagnosis of diabetic footen
dc.typedoctoralThesis
dc.rights.licenseBY-NC-ND
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/49015/Disertacija.pdf
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/49016/Dragana_Bubanja_Medicina.pdf


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