骨膜牵张技术用于糖尿病足治疗的理论基础及临床结果验证  

Periosteum distraction for the treatment of diabetic foot ulcer:theoretical basis and clinical verification

作　　者：刘杰[1,2,5] 花奇凯[1,5] 李山郎 余杰[1] 苏宏杰 丁毅 赵永鑫 苏永锋 陈炎 Liu Jie;Hua Qikai;Li Shanlang;Yu Jie;Su Hongjie;Ding Yi;Zhao Yongxin;Su Yongfeng;Chen Yan(Department of Bone and Joint Surgery,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China;Collaborative Innovation Center of Regenerative Medicine and Medical Biological Resources Development and Application,Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China;Department of Sports Medicine,Affiliated Hospital of Youjiang Medical College for Nationalities,Baise 533000,Guangxi Zhuang Autonomous Region,China;Guangxi Key Laboratory of Regenerative Medicine,Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China;Guangxi Diabetic Foot Limb Salvage Engineering and Research Center,Nanning 530021,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第一附属医院骨关节外科,广西壮族自治区南宁市530021 [2]广西医科大学再生医学与医用生物资源开发应用协同创新中心,广西壮族自治区南宁市530021 [3]右江民族医学院附属医院运动医学科,广西壮族自治区百色市533000 [4]广西医科大学再生医学研究中心,广西壮族自治区南宁市530021 [5]广西壮族自治区糖尿病足保肢工程研究中心,广西壮族自治区南宁市530021

出　　处：《中国组织工程研究》2022年第32期5236-5241,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(82060406,81601930),项目负责人:陈炎;中国博士后科学基金(2019M650235),项目负责人:陈炎;广西壮族自治区自然科学基金(2017GXNSFAA198318),项目负责人:陈炎;广西壮族自治区南宁市青秀区重点研发计划(2021003,2020053),项目负责人:陈炎、花奇凯;广西医科大学第一附属医院临床研究攀登计划(YYZS2020010),项目负责人:花奇凯。

摘　　要：背景:骨膜牵张也具有促进成骨和微血管生成作用,但能否用于治疗糖尿病足目前尚未明确。目的:对骨膜牵张促进骨和血管再生的研究进展进行综述,以明确该技术用于糖尿病足治疗的理论基础,并介绍其在治疗糖尿病足中的初步应用。方法:计算机检索万方医学网、中国知网、PubMed及Elsevier数据库收录的相关文献,中文检索词为:“牵张成组织技术、牵张成骨、胫骨横向骨搬移与糖尿病足、骨膜牵张、骨膜牵张成骨、骨膜牵张与糖尿病足”;英文检索词为“Distraction histogenesis,Distraction osteogenesis,Tibia transverse transport and diabetic foot,Periosteal distraction osteogenesis,Periosteal distraction and diabetic foot”。最终纳入42篇文献进行综述分析。结果与结论:①基于Ilizarov张力-应力法则或牵张成组织原理,牵张成骨技术已用于治疗骨缺损、骨不连等疾病,而牵张成骨伴随的成血管原理催生了胫骨横向骨搬移技术,该技术已经成功应用于治疗包括糖尿病足在内的下肢难愈性溃疡,取得良好的治疗效果。②研究发现对骨膜进行持续、稳定、缓慢的牵张可以促进骨和血管再生,即骨膜牵张成骨和成血管现象,该现象的机制可能与骨膜的结构和成分有关。③目前关于骨膜牵张的研究主要聚焦于其成骨功能,且主要停留在动物实验阶段而极少用于人体。与胫骨横向骨搬移促进血管再生从而用于治疗糖尿病足类似,骨膜牵张促进血管再生也可能用于治疗糖尿病足,此即骨膜牵张用于治疗糖尿病足的理论基础。④该课题组已初步将骨膜牵张用于临床治疗糖尿病足,且治疗效果良好,该文章通过展示用于骨膜搬移的器械、手术方法及典型病例。初步结果显示,由于骨膜牵张技术不需要截骨,手术操作要比胫骨横向骨搬移更加简单,手术时间更短;因为骨膜牵张技术缺少对胫骨钻孔和骨搬移的操作,缺�BACKGROUND:Pe riosteal distraction has been found to stimulate osteogenesis and angiogenesis;however,whether this technique can be used for the treatment of diabetic foot remains unclear.OBJECTIVE:To review the research progress of periosteal distraction in the promotion of osteogenesis and neovascularization,to clarify the theoretical basis of this technique for the treatment of diabetic foot,and to introduce its preliminary application in the treatment of diabetic foot.METHODS:Literature retrieval was conducted using computer in WanFang,CNKI,PubMed and Elsevier databases using the keywords of "distraction histogenesis,distra ction osteogenesis,ti bia transverse transport and diabetic foot,periosteal distra ction osteogenesis,periosteal distra ction and diabetic foot" in Chinese and English.Finally,42 articles were included for analysis.RESULTS AND CONCLUSION:Based on Ilizarov’s law of tension-stress or the principle of distraction histogenesis,distraction osteogenesis has been used to treat bone defects,nonunion and other orthopedic diseases.The angiogenesis accompanying distraction osteogenesis gave birth to the technique of tibial transve rse transfer,which has been successfully applied to refractory lower extremity ulcers including diabetic foot.Also based on the principle of distraction histogenesis,studies have found that a continuous,stable and slow distraction of the periosteum can promote bone and vascular regeneration,that is,the phenomenon of periosteal distra ction osteogenesis and angiogenesis.The mechanism of this phenomenon may be related to the structure and composition of the periosteum.However,the current research on periosteal distraction mainly focuses on its osteogenic function in animal experiments but hardly in humans.Like tibial transve rse transfer to promote angiogenesis for the treatment of diabetic foot,periosteal distraction angiogenesis may also be used to treat diabetic foot,which is the theo retical basis of periosteal distraction for the treatment of diabetic foot.Our prelimina

关 键 词：张力-应力法则 牵张成组织 牵张成骨 骨膜 骨膜牵张 骨膜牵张成骨 糖尿病足 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]