胫骨骨膜侧向牵张术治疗下肢慢性缺血性疾病  

Preliminary study of lateral tibia periosteum distraction for the treatment of chronic ischemic diseases of lower limbs

作　　者：曾纳新 曹政 游艺 甘萌 彭新宇 徐威 吴文皋 许进军 汤银魁 王栋[2] 王斌[2] 李岩[2] 张永红[2] 秦泗河 Zeng Naxin;Cao Zheng;You Yi;Gan Meng;Peng Xinyu;Xu Wei;Wu Wengao;Xu Jinjun;Tang Yinkui;Wang Dong;Wang Bin;Li Yan;Zhang Yonghong;Qin Sihe(Department of Orthopaedics,the First People's Hospital of Yueyang,Yueyang 414000,China;Orthopaedic Limb Reconstruction Ward,Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Orthopaedics,Affiliated Hospital of National Rehabilitation Assisted Devices Research Center,Beijing 100176,China)

机构地区：[1]岳阳市第一人民医院骨科,414000 [2]山西医科大学第二医院骨科肢体矫形重建病区,太原030001 [3]国家康复辅具研究中心附属康复医院,北京100176

出　　处：《中华骨科杂志》2021年第22期1607-1613,共7页Chinese Journal of Orthopaedics

基　　金：山西省重点研发计划项目(201803D31126)。

摘　　要：目的探讨胫骨骨膜侧向牵张术治疗糖尿病足和脉管炎足的疗效。方法回顾性分析2019年6月至2020年5月采用胫骨骨膜侧向牵张术治疗并获得随访的13例(16足)患者资料,男9例(12足),女4例(4足);年龄39~77岁,平均66岁;左足7例,右足9例;5例为糖尿病足,1例为糖尿病足合并动脉硬化闭塞症,2例为血栓闭塞性脉管炎,5例为动脉硬化闭塞症。术中将胫骨骨膜切开并置入牵张装置,其中3例双足溃疡者胫骨骨膜牵张器安置于较为严重的一侧。术后第3天起开始牵张骨膜,速度约0.75 mm/d,调整时限为2周,2周后手术取出牵张装置。评价术后足部毛细血管充盈和创面恢复情况,对手术前、后的足部皮温、疼痛视觉模拟评分(visual analogue scale,VAS)、足末梢血氧饱和度进行统计学分析,同时采用CT血管造影(CT angiography,CTA)观察双下肢血管情况。结果术后13例患者均获得随访,随访时间2~12周,平均3.85周;术前13例患者VAS评分为(5.31±1.84)分(范围2~9分),术后2周为(2.46±1.39)分(范围1~6分),两者比较差异有统计学意义(t=6.124,P<0.001)。术前1例患足血氧饱和度未测出,其余12例为87.83%±14.83%(范围50%~98%),术后2周为92.33%±7.91%(范围75%~99%),两者比较差异无统计学意义(t=1.124,P=0.285)。术前10例患者足部皮温为(35.68±0.85)℃(范围34.00~36.60℃),术后为(36.23±0.46)℃(范围35.50~36.90℃),两者比较差异有统计学意义(t=3.197,P=0.008)。术后2周毛细血管充盈试验示毛细血管充盈反应较术前明显改善。所有患者均于术前行CTA检测,11例患者术后2周取出牵张装置后复查CTA,与术前CTA相比手术侧肢体可见明显的新生血管显影。除1例血栓闭塞性脉管炎患者(患足疼痛为主,无创面症状)外,其余12例患者中2例因合并心衰或肾衰而致创面未愈合、另外10例于术后1个月创面明显好转。结论胫骨骨膜侧向牵张术可用于治疗下肢慢性缺血性疾病,术后疗效满�Objective To investigate the effect of lateral tibial periosteum distraction on diabetic foot and vasculitis foot.Methods A retrospective analysis of 13 patients(16 feet)who received lateral tibial periosteal distraction between June 2019 and May 2020 were included in the study.9 males and 4 females;aged 39-77 years(average 66 years);left foot 7 cases,right foot 9 cases.5 cases were patients with diabetic foot,1 case was diabetic foot with arteriosclerosis obliterans,2 cases were thromboembolic vasculitis,and 5 cases were arteriosclerosis obliterans.The tibial periosteum was dissected and a distraction device was placed.In the 3 patients with foot ulcers,tibial periosteum distraction devices were placed on the severer side.The periosteal distraction began on the third day after surgery,about 0.75 mm/d,the adjustment was done usually in two weeks.Two weeks later,the stretch plate was removed surgically.The followings were evaluated:visual analogue scale(VAS)pain score,foot peripheral oxygen saturation,foot capillary filling test,lower extremity arterial CT angiography(CTA),etc.Results All 13 patients were followed up for 2-12 weeks,with an average of 3.85 weeks.VAS pain score:the average pain score of 13 patients with preoperative foot pain was 5.31±1.84(range,2-9)points,and 2 weeks after surgery,the average value was 2.46±1.39(range,1-6)points with statistical significance(t=6.124,P<0.001);peripheral foot oxygen saturation:the average preoperative blood oxygen saturation of 12 patients was 87.83%±14.83%(range,50%-98%),1 patient was not detected before surgery,and 2 weeks after operation,the average blood oxygen saturation was 92.33%±7.91%(range,75%-99%).There was no significant difference between them(t=1.124,P=0.285).The foot skin temperature of 10 patients was 35.68±0.85℃(range,34.00-36.60℃)before surgery and 36.23±0.46℃(range,35.50-36.90℃)after surgery,and the difference was statistically significant(t=3.197,P=0.008).Capillary filling test:2 weeks after operation,the capillary filling response wa

关 键 词：胫骨 伊利扎罗夫技术 骨膜 糖尿病足 

分 类 号：R687.3[医药卫生—骨科学]