胫骨横向骨搬移微血管网重建技术在糖尿病足溃疡治疗中的应用体会  

Clinical experience with tibial transverse transport plus microcirculation reconstruction for treatment of diabetic foot ulcer

作　　者：王建波 贾中伟[2] 魏杰[2] Wang Jianbo;Jia Zhongwei;Wei Jie(Department of Orthopaedics,Yushe County Hospital of Traditional Chinese Medicine,Shanxi 031800,China;不详)

机构地区：[1]山西省榆社县中医院骨科,031800 [2]山西省人民医院骨科

出　　处：《中国药物与临床》2020年第9期1432-1434,共3页Chinese Remedies & Clinics

基　　金：山西省教育厅研究生联合培养基地人才培养项目(2017JD20)。

摘　　要：目的探讨胫骨横向骨搬移微血管网重建技术在糖尿病足溃疡治疗中的应用价值。方法对2017年3月至2019年3月利用胫骨横向骨搬移技术治疗的21例糖尿病足进行回顾性分析,男性16例,女性5例,平均年龄(63±9)岁,左足12例,右足9例。所有患者术前均给予抗感染、监控血糖、纠正低蛋白血症等对症支持治疗;术中于患侧胫骨中段内侧面上做一范围约1.5 cm×8.0 cm骨窗,安置专用横向外固定牵引架,酌情行患足清创、负压封闭引流(VSD),术后第5天开始缓慢横向搬移骨窗;术前、术后测量踝肱指数及密歇根神经体征评分,评价周围血管和周围神经恢复情况。结果21例患者中20例术后获得随访,时间为3~20个月,平均随访12.4个月,20例患足创面均得到愈合;术后踝肱指数及密歇根神经体征评分较术前均有明显改善,差异均有统计学意义(P<0.05);患足功能达到正常运动和日常生活需要。结论胫骨横向骨搬移技术可以重建患足微循环网,促进溃疡创面愈合,有利于患肢周围血管及周围神经恢复,具有手术操作简单、临床疗效确切、保肢成功率高的优点,是治疗糖尿病足溃疡的有效方法之一。Objective To determine the value of tibial transverse transport plus microcirculation reconstruction(TTT-MCR)in the treatment of diabetic foot ulcers.Methods A retrospective analysis was performed on 21 cases of diabetic foot treated with TTT-MCR between March 2017 and March 2019.The subjects comprised 16 males and 5 females,with a mean age of(63±9)years,presenting foot ulcers 12 on the left and 9 on the right.All patients were given symptomatic and supportive care such as anti-infective therapy,blood glucose monitoring,and correction of hypoalbuminemia before operation.During the operation,fenestration of about 1.5 cm×8.0 cm in size was made on the medial surface of middle segment of the affected tibia.A specially designed transverse external fixation and traction frame was installed.Foot debridement and vacuum suction were done as appropriate.Slow transverse transport of the bone fenestration was started on the 5th day after operation.The ankle brachial index and Michigan Neuropathy Screening Instrument(MNSI)score before and after surgery were measured,and recovery of peripheral blood vessels and nerves were evalucated.Results Twenty of the 21 patients were followed up for 3 to 20 months(mean:12.4 months).These 20 patients experienced successful healing of the foot ulcers.The ankle brachial index and MNSI scores were significantly improved compared with baseline(both P<0.05).The foot function on the affected side was competent for usual exercise and daily activities.Conclusion Surgery with tibial transverse transport may reconstruct the microcirculation,promote healing of ulcer wounds,and facilitate the recovery of blood vessels and peripheral nerves of the affected limb.This technique seems to be advantageous in terms of simple procedure,clinically definite efficacy,and higher chance for limb-sparing,and therefore can be an effective treatment for diabetic foot ulcers.

关 键 词：糖尿病足溃疡 骨搬移 Ilizarov张力-应力法则 血管再生 

分 类 号：R687.3[医药卫生—骨科学]