抗生素骨水泥联合改良胫骨横向骨搬移治疗重症糖尿病足  

Antibiotic Bone Cement Combined with Modified Tibial Lateral Bone Transport for the Treatment of Severe Diabetic Foot

作　　者：刘敏峰[1] 邓智明[1] 朱振兴[1] 孔颖宏[2] LIU Min-feng;DENG Zhi-ming;ZHU Zhen-xing;KONG Ying-hong(Department of Hand and Foot Surgery,Changshu No.2 People's Hospital,Changshu 215500,China;Department of Endocrinology,Changshu No.2 People's Hospital,Changshu 215500,China)

机构地区：[1]常熟市第二人民医院手足外科,江苏常熟215500 [2]常熟市第二人民医院内分泌科,江苏常熟215500

出　　处：《骨科》2022年第4期353-357,共5页ORTHOPAEDICS

摘　　要：目的探讨应用抗生素骨水泥联合改良胫骨横向骨搬移治疗重症糖尿病足的临床疗效。方法选取2018年5月至2021年5月我院收治的24例重症糖尿病足病人,应用抗生素骨水泥联合改良胫骨横向骨搬移治疗。本组病人有5~20年的糖尿病史,其中Wagner 3级病人6例,Wagner 4级病人17例,Wagner 5级病人1例。术后观察创面愈合情况,术前及术后测量患肢皮温、疼痛视觉模拟量表(VAS)评分、患肢感觉阀值、踝肱指数;术前和术后3个月,行双下肢CT血管造影(CT angiography,CTA)。结果24例病人均获得随访,随访时间为(23.67±5.74)个月(9~36个月),患肢均保肢成功,创面全部愈合。术后患肢皮温为(31.32±0.52)℃,踝肱指数为0.87±0.16,均较术前显著升高,术后的感觉阈值为(24.81±2.62)Volt,VAS评分为(4.70±0.58)分,均较术前显著降低,差异有统计学意义(P<0.05)。根据病人治疗前后的双下肢血管CTA对比发现,治疗后腿部侧枝动脉增加明显,未见静脉血栓,血流及循环改善。结论应用抗生素骨水泥联合改良胫骨横向骨搬移治疗重症糖尿病足的临床疗效好,对重症糖尿病足(Wagner分级3~5级)的保肢治疗有积极意义。Objective To investigate the clinical effect of antibiotic cement with the modified tibia in the treatment of the severe diabetic foot.Methods A total of 24 patients with severe diabetic foot who were admitted to our hospital from May 2018 to May 2021 were selected and treated with antibiotic bone cement combined with modified transverse tibial bone transfer.All patients had a history of diabetes ranging from 5 to20 years,including 6 patients with Wagner grade 3,17 patients with Wagner grade 4,and 1 patient with Wagner grade 5.The wound healing was observed after operation,and the skin temperature of the affected limb,the pain visual analog scale(VAS)score,the sensory threshold of the affected limb,the ankle-brachial index and CT angiography(CTA)were measured before and after the operation.Results All 24 patients were followed up for(23.67±5.74)months(9-36 months).All affected limbs were successfully salvaged and all wounds healed.The postoperative skin temperature of the affected limb was(31.32±0.52)℃,and the anklebrachial index was 0.87±0.16,which were significantly higher than those before operation;the postoperative sensory threshold was(24.81±2.62)Volt,and the VAS score was 4.70±0.58,which were significantly lower than those before operation(P<0.05).According to the CTA comparison of blood vessels of both lower extremities before and after treatment,it was found that the collateral arteries of the legs increased significantly after treatment,and no venous thrombosis was found,indicating that blood flow and circulation were improved.Conclusion The clinical effect of antibiotic bone cement combined with modified lateral tibial bone transfer in the treatment of severe diabetic foot is satisfactory,and it has positive significance for the limb salvage treatment of severe diabetic foot(Wagner grades 3-5).

关 键 词：抗生素骨水泥 胫骨横向骨搬移 糖尿病足 

分 类 号：R587.2[医药卫生—内分泌] R687.3[医药卫生—内科学]