改良胫骨横向骨搬移微循环重建术治疗终末期糖尿病足  

Modified transverse tibial bone transplantation and microcirculation reconstruction for the treatment of end-stage diabetic foot

作　　者：丁小方 徐海林[3,4] 王元利 纪坤羽 杨黎黎 DING Xiao-fang;XU Hai-lin;WANG Yuan-li;JI Kun-yu;YANG Li-li(不详;Department of Traumatic Orthopaedics,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020 [2]北京市隆福医院北京市中西医结合老年病研究所,北京100010 [3]北京大学人民医院创伤骨科,北京100044 [4]北京大学人民医院糖尿病足治疗中心,北京100044

出　　处：《中国骨伤》2021年第5期462-466,共5页China Journal of Orthopaedics and Traumatology

基　　金：首都卫生发展科研专项(编号:2020-2-4086);北京市东城区卫健委科研项目基金(编号:2018-13)。

摘　　要：目的:探讨采用改良胫骨横向骨搬移微循环重建术治疗终末期糖尿病足的临床疗效。方法:回顾性分析2016年8月至2018年6月采用改良胫骨横向骨搬移微循环重建术治疗的87例糖尿病足患者的临床资料,其中男54例,女33例;年龄39~95 (68.9±11.3)岁;按照Wagner分级,2级2例,3级35例,4级50例;糖尿病病程10~16(13.0±2.2)年;糖尿病足病程21~48(34.2±8.6) d。记录术后并发症情况,比较术前及术后3个月患足部皮温、疼痛视觉模拟评分(visual analogue scale,VAS),踝肱指数(ankle brachial index,ABI)及创面愈合情况。结果:87例患者均获得随访,时间4~19(12.6±2.8)个月。骨搬运期间,2例发生钉道皮下组织液化、渗液,未做特殊处理,自行结痂。经骨搬运术治疗后,1例患者因感染较重行踝关节线上5 cm截肢;1例患者创面愈合后1年时,患足再次破溃,在同一部位再次行骨搬运,术后8周创面完全愈合。87例患者创面愈合时间3~24(11.9±3.8)周。术后3个月足部皮温(31.70±0.32)℃较术目前(28.90±0.91)℃增高(t=5.72 P=0.006);术后 3 个月 VAS 评分(2.20±0.13)分较术前(7.80±0.72)分降低(t=25.38,P=0.000);术后3个月ABI 0.98±0.24较术前0.48±0.30明显改善(t=14.68,P=0.000)。结论:改良胫骨横向骨搬移术能有效重建患肢小腿以下微血管网,促进周围血管恢复,从而促进患足创面愈合,减少或避免截肢。同时,改良截骨法创面更小,手术操作更简便,是治疗终末期糖尿病足的有效方法之一。Objective:To explore clinical effect of modified transverse tibial bone transfer microcirculation reconstruction in treating end-stage diabetic foot.Methods:From August 2016 to June 2018,87 patients with diabetic foot treated with modified tibial transverse bone removal and microcirculation reconstruction,inclduing 54 males and 33 females;aged from 39 to 95 years old with an average of(68.9±11.3) years old;2 patients were grade 2,37 patients were grade 3 and 50 patients were grade 4 according to Wagner’s classification;the courses of diabetic were for 10 to 16 years with an average of(13.0±2.2)years;the courses of diabetic feet were for 21 to 48 days with an avergae of(34.2±8.6) days.Postoperative comlications were observed.Skin temperature,visual analogue scale(VAS) and ankle brachial index(ABI) and wound healing were recorded before and 3 months after operation.Results:All patients were followed up for 4 to 19 months with an average of(12.6±2.8)months.Two patients occurred subcutaneous tissue liquefaction and seepage under needle passage during bone transfer,and seabed without special treatment.One patient was performed amputation above 5 cm of ankle joint because of severe infection,and 1 patient occurred re-ulceration at 1 year after wound healing,bone transfer was performed again at the same site,and was completely healed at 8 weeks after operation.The healing time of wound ranged from 3 to 24 weeks with an average of(11.9±3.8) weeks.Foot skin temperature before operation was(28.9±0.91)℃,and increased to(31.70±0.32)℃ at 3 months after operation(t=5.72 P=0.006);VAS score before opertaion was(7.80±0.72),and improved to(2.20±0.13) at 3 months after operation(t=25.38,P=0.000):ABI before operation was(0.48±0.30),increased to(0.98±0.24) at 3 months after oeprtaion(t=14.68,P=0.000).Conclusion:Modified lateral tibial bone transfer could effectively reconstruct microvascular network under lower leg,promote recovery of peripheral blood vessels,and promote wound healing of foot,reduce or avoid amputati

关 键 词：糖尿病足 微循环 胫骨 骨重建 

分 类 号：R687[医药卫生—骨科学]