胫骨横向骨搬移微循环重建术联合抗生素骨水泥在糖尿病足保肢中的应用价值研究  

The application value of tibial transverse transport microvascular reconstruction combined with antibiotic bone cement in the limb salvage of diabetic foot

作　　者：陈文峰[1] 李绪松[1] 郑臣校[1] 苏永康[1] Chen Wenfeng;Li Xusong;Zheng Chenxiao;Su Yongkang(Department of Orthopedics,Traditional Chinese Medicine Hospital of Zhongshan,Zhongshan 528400,China)

机构地区：[1]中山市中医院骨二科,中山528400

出　　处：《中国医师进修杂志》2023年第8期754-757,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨胫骨横向骨搬移(TTT)微循环重建术联合抗生素骨水泥在糖尿病足保肢中的应用价值。方法回顾性选择2018年1月至2021年1月在中山市中医院接受TTT微循环重建术和/或抗生素骨水泥治疗的糖尿病足患者77例,按手术方式分为对照组(采用TTT微循环重建术,47例)和联合组(采用TTT微循环重建术联合抗生素骨水泥治疗,30例),比较两组创面愈合率、保肢率、溃疡愈合时间、骨窗愈合时间、创面感染控制情况、患侧下肢血运情况和患侧周围神经功能恢复情况。结果两组截肢率比较差异无统计学意义(P>0.05),但联合组创面愈合率高于对照组[90.00%(27/30)比68.08%(32/47)],溃疡愈合时间、骨窗愈合时间短于对照组[(12.55±2.14)周比(15.01±3.17)周、(17.47±2.09)周比(19.00±2.58)周],差异有统计学意义(P<0.05)。联合组术后6 d创面分泌物细菌培养阳性率低于对照组[(20.00%(6/30)比44.68%(21/47)],差异有统计学意义(P<0.05);术后3个月时联合组患侧足背皮肤温度及踝肱指数高于对照组[(31.05±1.74)℃比(29.27±1.66)℃、0.93±0.29比0.80±0.19],差异有统计学意义(P<0.05),但两组视觉模拟量表评分、10 g尼龙线测试值比较差异无统计学意义(P>0.05)。结论TTT联合抗生素骨水泥用于糖尿病足保肢可获得更佳的创面愈合效果及感染控制效果,患肢血运改善更显著。Objective To analyze the application value of tibial transverse transport(TTT)microvascular reconstruction combined with antibiotic bone cement in the limb salvage of diabetic foot.Methods Seventy-seven patients with diabetic foot admitted to the Traditional Chinese Medicine Hospital of Zhongshan from January 2018 to January 2021 were enrolled retrospectively,and they were divided into the control group(performed TTT microvascular reconstruction,47 cases)and the combined group(performed TTT microvascular reconstruction combined with antibiotic bone cement,30 cases)according to the surgical method.Wound healing rate,limb salvage rate,the ulcer healing time,bone window healing time,wound infection control status,affected side lower limb vascular blood supply situation,and peripheral nerve function recovery were compared between the two groups.Results The amputation rate between the two groups had no significant difference(P>0.05),but the healing rate in the combined group was higher than that in the control group:90.00%(27/30)vs.68.08%(32/47);and the ulcer healing time,bone window healing time in the combined group were shorter than those in the control group:(12.55±2.14)weeks vs.(15.01±3.17)weeks,(17.47±2.09)weeks vs.(19.00±2.58)weeks,there were statistical differences(P<0.05).The positive percentage of bacteria culture in wound secretions in the combined group after the surgery for 6 d was lower than that in the control group:20.00%(6/30)vs.44.68%(21/47),there was statistical difference(P<0.05).After the surgery for 3 months,the dorsal skin temperature and ankle brachial index in the combined group were higher than those in the control group:(31.05±1.74)℃vs.(29.27±1.66)℃,0.93±0.29 vs.0.80±0.19,there were statistical differences(P<0.05),but the scores of visual analog scale(VAS)and 10 g nylon line test values between the two groups had no significant differences(P>0.05).Conclusions TTT combined with antibiotic bone cement can achieve better wound healing and infection control effect in the limb salvage

关 键 词：糖尿病足 微循环 胫骨横向骨搬移 抗生素骨水泥 

分 类 号：R687.3[医药卫生—骨科学] R587.2[医药卫生—外科学]