胫骨横向骨搬移技术联合改良神经松解术治疗糖尿病足溃疡  

Effectiveness of tibial transverse transport combined with modified neurolysis in treatment of diabetic foot ulcers

作　　者：常树森 杨尉 宋荷花 陈伟 周健 张芳 闫雪萍 莫小金 聂开瑜 邓呈亮 魏在荣 CHANG Shusen;YANG Wei;SONG Hehua;CHEN Wei;ZHOU Jian;ZHANG Fang;YAN Xueping;MO Xiaojin;NIE Kaiyu;DENG Chengliang;WEI Zairong(Department of Burns and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou,563003,P.R.China;The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University,Zunyi Guizhou,563003,P.R.China;Organ Transplantation Center,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou,563003,P.R.China;Department of Medical Aesthetic Surgery,Guizhou Provincial People’s Hospital,Guiyang Guizhou,550002,P.R.China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,贵州遵义563003 [2]遵义医科大学组织损伤修复与再生医学省部共建协同创新中心,贵州遵义563003 [3]遵义医科大学附属医院器官移植中心,贵州遵义563003 [4]贵州省人民医院医学美容科,贵阳550002

出　　处：《中国修复重建外科杂志》2023年第11期1410-1417,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：贵州省创面外科整合治疗科技创新人才团队项目[黔科合平台人才(2020)5012];省部共建协同创新中心项目[教科技厅函(2020)39号];创面精准修复创新人才平台载体建设项目[遵市科人平台(2021)3号];上海王正国创伤医学发展基金会(SZYZ-TR-05)。

摘　　要：目的通过前瞻性随机对照研究,探讨胫骨横向骨搬移(tibial transverse transport,TTT)技术联合改良神经松解术治疗糖尿病足溃疡(diabetic foot ulcer,DFU)的疗效。方法以2020年2月—2022年2月收治的DFU伴糖尿病周围神经病变患者作为研究对象,其中31例符合选择标准纳入研究。采用随机数字表法将患者分为两组,其中试验组15例采用TTT技术联合改良神经松解术治疗,对照组16例采用单纯TTT技术治疗。两组患者性别、年龄、DFU病程、溃疡面积、Wagner分级,以及术前足部皮温、疼痛视觉模拟评分(VAS)、踝肱指数(ankle-brachial index,ABI)、腓总神经运动神经传导速度(motor nerve conduction velocity,MNCV)、胫神经MNCV、腓深神经MNCV、足跟两点辨别觉(two-point discrimination,2-PD)及腓总神经横截面积(cross-section area,CSA)比较,差异均无统计学意义(P>0.05)。比较两组溃疡创面愈合时间,术前以及术后6、12个月足部皮温、VAS评分、ABI、足跟2-PD、腓总神经CSA;术前及术后12个月腓总神经、胫神经及腓深神经MNCV差值(变化值)。结果术后两组患者均获随访,随访时间12~24个月,平均13.9个月。两组手术切口均Ⅰ期愈合,骨搬移期间无针道感染发生;溃疡创面均顺利愈合,愈合时间组间差异无统计学意义(P>0.05),随访期间溃疡无复发。术后12个月,两组腓总神经、胫神经、腓深神经MNCV均较术前加快(P<0.05);术后上述指标变化值试验组优于对照组(P<0.05)。两组患者术后6、12个月足部皮温、VAS评分、ABI、足跟2-PD、腓总神经CSA均较术前改善(P<0.05);其中,足跟2-PD随着时间推移逐渐改善且差异有统计学意义(P<0.05)。术后试验组足跟2-PD、VAS评分优于对照组(P<0.05),ABI、足部皮温、腓总神经CSA差异均无统计学意义(P>0.05)。结论对于DFU患者,与单纯TTT技术相比,联合改良神经松解术可同时解决微循环障碍和神经卡压问题,提高神经功能恢复质�Objective To investigate the effectiveness of tibial transverse transport(TTT)combined with modified neurolysis in treatment of diabetic foot ulcer(DFU)through a prospective randomized controlled study.Methods The patients with DFU and diabetic peripheral neuropathy,who were admitted between February 2020 and February 2022,were selected as the research objects,of which 31 cases met the selection criteria and were included in the study.The patients were divided into two groups by random number table method.The 15 patients in the trial group were treated with TTT combined with modified neurolysis,and the 16 patients in the control group received treatment with TTT alone.There was no significant difference in gender,age,duration of DFU,ulcer area,Wagner classification,as well as preoperative foot skin temperature,visual analogue scale(VAS)score,ankle-brachial index(ABI),motor nerve conduction velocity(MNCV)of the common peroneal nerve,MNCV of the tibial nerve,MNCV of the deep peroneal nerve,two-point discrimination(2-PD)of heel,and cross-sectional area(CSA)of the common peroneal nerve between the two groups(P>0.05).The time for ulcer healing,foot skin temperature,VAS scores,ABI,2-PD of heel,and CSA of the common peroneal nerve before operation and at 6 and 12 months after operation were recorded and compared between groups.The differences in MNCV of the common peroneal nerve,MNCV of the tibial nerve,and MNCV of the deep peroneal nerve between pre-operation and 12 months after operation were calculated.Results All patients in both groups were followed up 12-24 months(mean,13.9 months).The surgical incisions in both groups healed by first intention and no needle tract infections occurred during the bone transport phase.Ulcer wounds in both groups healed successfully,and there was no significant difference in the healing time(P>0.05).During the follow-up,there was no ulcer recurrences.At 12 months after operation,the MNCV of the common peroneal nerve,the MNCV of the tibial nerve,and the MNCV of the deep peroneal nerve

关 键 词：糖尿病足 溃疡 胫骨横向骨搬移技术 周围神经松解术 

分 类 号：R587.2[医药卫生—内分泌] R632.1[医药卫生—内科学]