文章摘要

胫骨横向骨搬移技术治疗糖尿病足的临床效果

作者: 1万蓉, 2尹碧, 3徐伟才, 4朱义用
1 联勤保障部队第904医院质量管理科，江苏 无锡 214044
2 联勤保障部队第904医院体检中心，江苏 无锡 214044
3 联勤保障部队第904医院卫勤处，江苏 无锡 214044
4 无锡市中医医院骨科，江苏 无锡 214000
通讯: 徐伟才 Email: 43791393@qq.com
DOI: 10.3978/j.issn.2095-6959.2022.09.026
基金: 无锡市卫健委科技成果与适宜推广项目(T202018)。

摘要

目的：探讨胫骨横向骨搬移(transverse tibial transport，TTT)技术治疗糖尿病足的临床效果。方法：回顾性分析2014年1月至2021年1月联勤保障部队第904医院治疗的58例Wagner分级III~V级糖尿病足患者。其中2014年1月至2016年12月治疗的34例为对照组，采用常规清创换药；2017年1月至2021年1月治疗的24例为研究组，在常规清创换药的基础上，增加TTT技术。比较对照组与研究组的溃疡愈合率和截肢率；在溃疡愈合患者末次随访时，比较两组患者的足部溃疡愈合时间、疼痛评分、皮肤温度和踝肱指数(ankle-brachial index，ABI)；同时对研究组溃疡愈合病例进行自身对照，对比术前、术后6个月足部疼痛评分、皮肤温度和ABI。结果：本研究58例均获得随访，随访时间为6~36(16.6±8.88)个月。对照组34例，溃疡愈合为23例(67.65%)，截肢为11例(32.35%)，研究组24例，溃疡愈合为22例(91.67%)，截肢为2例(8.33%)，两组比较有显著差异(P<0.05)。对照组溃疡愈合23例与研究组溃疡愈合22例的末次随访时，溃疡愈合时间、疼痛评分、皮肤温度和ABI均有显著差异(均P<0.01)。在研究组溃疡愈合22例中，术后6个月足部疼痛评分明显低于术前评分(P<0.01)，皮肤温度明显高于术前(P<0.01)，ABI明显高于术前(P<0.01)。结论：TTT技术能有效重建小腿微细血管网，改善患肢血供，促使皮肤温度升高，减轻足部疼痛，促进溃疡愈合。
关键词： 糖尿病足；胫骨横向骨搬移；踝肱指数；Ilizarov张力应力法则；血管再生；微细血管网

Clinical effect of transverse tibial transport for treatment of diabetic foot

Authors: 1WAN Rong, 2YIN Bi, 3XU Weicai, 4ZHU Yiyong
1 Department of Quality Management, The 904th Hospital of Joint Logistics Support Force, Wuxi Jiangsu 214044, China
2 Health Examination Center, The 904th Hospital of Joint Logistics Support Force, Wuxi Jiangsu 214044, China
3 Department of Medical Service, The 904th Hospital of Joint Logistics Support Force, Wuxi Jiangsu 214044, China
4 Department of Orthopedics, Wuxi Hospital of Traditional Chinese Medicine, Wuxi Jiangsu 214000, China

CorrespondingAuthor: XU Weicai Email: 43791393@qq.com

DOI: 10.3978/j.issn.2095-6959.2022.09.026

Foundation: This work was supported by the Science and Technology Achievements and Appropriate Technology Promotion Project of Wuxi Municipal Health Commission, China (T202018).

Abstract

Objective: To investigate the clinical effect of transverse tibial transport (TTT) for treatment of diabetic foot. Methods: A retrospective analysis of 58 patients with Wagner grade III–V diabetic foot were treated between January 2014 and January 2021 in the 904th Hospital of Joint Logistics Support Force of PLA. Among them, 34 cases as the control group had undergone the conventional debridement and dressing change from January 2014 to December 2016; and remaining 24 cases as the study group had undergone the surgery of TTT on the basis of routine debridement and dressing change from January 2017 to January 2021. The ulcer healing rate and amputation rate of the control group and the study group were compared; the foot ulcer healing time, pain score, skin temperature, and ankle-brachial index (ABI) of the 2 groups at the last follow-up were compared; at the same time, self-comparison was performed on the patients with ulcer healing in the study group, and the foot pain score, skin temperature and ABI were compared before and 6 months after surgery. Results: All 58 patients were followed up for 6–36 (16.6±8.88) months. Among the 34 cases in the control group, 23 (67.65%) had ulcer healing and 11 (32.35%) underwent amputation. Among the 24 cases in the study group, 22(91.67%) had ulcer healing and 2 (8.33%) underwent amputation. There was significant difference between the 2 groups (P<0.05). There were significant differences in ulcer healing time, pain score, skin temperature and ABI (all P<0.01) between 23 cases of ulcer healing in the control group and 22 cases of ulcer healing in the study group. The foot pain score was significantly lower than one before operation (P<0.01), the skin temperature and ABI significantly higher than one before operation (P<0.01) in 22 cases of ulcer healing in the study group at 6 months after operation. Conclusion: TTT can effectively reconstruct calf microvascular network, improve blood supply of affected limb, increase skin temperature, relieve pain and promote ulcer healing.

Keywords： diabetic foot; transverse tibial transport; ankle-brachial index; Ilizarov’s tension-stress rule; angiogenesis; microvascular network

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