胫骨中段及近端皮质横向搬移治疗糖尿病足溃疡的疗效和安全性比较研究  

Comparative study on the efficacy and safety of middle tibial cortex transverse transport and proximal tibial cortex transverse transport in the treatment of diabetic foot ulcer

作　　者：覃文聪 杨思捷 林震迅 聂新宇 苏宏杰 花奇凯[1,2] QIN Wencong;YANG Sijie;LIN Zhenxun;NIE Xinyu;SU Hongjie;HUA Qikai(Department of Bone and Joint Surgery,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China;Diabetic Foot and Limb Preservation Engineering Research Center of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi,China;Collaborative Innovation Centre for Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry,Nanning 530021,Guangxi,China)

机构地区：[1]广西医科大学第一附属医院骨关节外科,广西南宁市530021 [2]广西壮族自治区糖尿病足保肢工程研究中心,广西南宁市530021 [3]再生医学与医用生物资源开发应用省部共建协同创新中心,广西南宁市530021

出　　处：《微创医学》2023年第3期288-293,共6页Journal of Minimally Invasive Medicine

基　　金：国家自然科学基金(编号:82260448);广西重点研发计划项目(编号:2021AB11027);广西医科大学第一附属医院临床研究攀登计划高峰项目(编号:YYZS2020010);南宁市青秀区重点研发计划项目(编号:2020053)。

摘　　要：目的比较胫骨中段皮质横向搬移(MTCTT)和胫骨近端皮质横向搬移(PTCTT)治疗糖尿病足溃疡(DFU)的疗效和安全性。方法选择接受MTCTT治疗的100例DFU患者为MTCTT组,同期接受PTCTT治疗且一般资料与MTCTT组均衡可比的90例DFU患者为PTCTT组。对比两组患者的手术相关情况、足部溃疡愈合率、愈合时间、截肢率、复发率及术后并发症发生率。结果所有患者均获随访,随访时间3~24个月,平均5.2个月。MTCTT组手术时间、住院时间、术中出血量均长/多于PTCTT组,差异均有统计学意义(均P<0.05)。两组足部溃疡愈合率、愈合时间、截肢率和复发率比较,差异均无统计学意义(均P>0.05)。MTCTT组术后骨折、截骨块区域感染的发生率均高于PTCTT组,差异均有统计学意义(均P<0.05)。结论MTCTT和PTCTT均能有效地促进糖尿病溃疡愈合,降低复发率及截肢率,是治疗DFU的有效方法。但PTCTT创伤更小,并发症发生风险更低,是更理想和安全的手术方式。Objective To compare the efficacy and safety of middle tibial cortex transverse transport(MTCTT)and proximal tibial cortex transverse transport(PTCTT)in the treatment of diabetic foot ulcer(DFU).Methods A total of 100 DFU patients who received MTCTT treatment were selected as the MTCTT group,and 90 DFU patients who received PTCTT treatment in the same period and whose general information was comparable with that of the MTCTT group were selected as the PTCTT group.The operation-related conditions,foot ulcer healing rate,healing time,amputation rate,recurrence rate and postoperative complications incidences were compared between the two groups.Results All patients were followed up for 3 to 24 months,with an average of 5.2 months.The operation time,hospital stay,and intraoperative blood loss in the MTCTT group were longer/more than those in the PTCTT group,with statistically significant differences(all P<0.05).There were no statistically significant differences in the foot ulcer healing rate,healing time,amputation rate and recurrence rate between the two groups(all P>0.05).The incidences of postoperative fracture and osteotomy site infection in the MTCTT group were higher than those in the PTCTT group,with statistically significant differences(all P<0.05).Conclusion Both MTCTT and PTCTT can effectively promote the healing of diabetic ulcer,reduce the recurrence rate and amputation rate,and are effective methods for the treatment of DFU.However,PTCTT is a more ideal and safer surgical method with less trauma and lower risks of complications.

关 键 词：胫骨横向骨搬移 糖尿病足溃疡 疗效 并发症 

分 类 号：R587.2[医药卫生—内分泌]