游离股前外侧穿支皮瓣与旋股外侧动脉降支组织瓣移植治疗糖尿病足的效果比较  

Comparison of the efficacies of free anterolateral thigh perforator flap and descending branch tissue flap of lateral circumflex femoral artery transplantation in the treatment of diabetic foot

作　　者：华振 荆银磊 戴炜 赵卓伟 Hua Zhen;Jing Yinlei;Dai Wei;Zhao Zhuowei(Department of Burns and Plastic Surgery,The Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院烧伤整形科,西安710038

出　　处：《国际医药卫生导报》2024年第10期1638-1642,共5页International Medicine and Health Guidance News

基　　金：陕西省重点研发计划(2022ZDLSF04-03)。

摘　　要：目的探讨游离股前外侧穿支皮瓣与游离旋股外侧动脉降支组织瓣移植分别联合封闭负压引流技术对糖尿病足的治疗效果。方法前瞻性选取2018年1月至2023年3月于空军军医大学第二附属医院接受治疗的94例糖尿病足患者为研究对象,按随机数字表法分为A、B组。A组47例接受游离股前外侧穿支皮瓣移植,其中男24例、女23例,年龄(53.26±11.52)岁,创面范围4.2 cm×5.4 cm~8.3 cm×10.2 cm,病变部位分布为足背15例、足踝18例、足跟14例;B组47例接受游离旋股外侧动脉降支组织瓣移植,其中男26例、女21例,年龄(51.34±10.89)岁,创面范围3.5 cm×4.5 cm~7.5 cm×9.5 cm,病变部位分布为足背17例、足踝16例、足跟14例;两组术前均行封闭负压引流清创。比较两组患者疗效、创面愈合情况、创面生长细胞因子[血管内皮生长因子(VEGF)、碱性成纤维生长因子(bFGF)、转化生长因子-β1(TGF-β1)]、皮瓣感觉功能、行走能力[采用Holden步行功能分级量表评估]。采用t检验、χ^(2)检验、秩和检验。结果治疗后6个月,A组治疗总有效率高于B组[97.87%(46/47)比87.23%(41/47)],差异有统计学意义(χ^(2)=3.859,P=0.049);A组创面愈合时间(28.98±4.49)d、住院时间(18.98±5.36)d、肉芽组织形成时间(21.58±4.22)d,均短于B组的(31.38±4.76)d、(22.38±6.42)d、(23.65±4.59)d,差异均有统计学意义(均P<0.05);A组术后1个月创面VEGF(113.13±12.82)ng/L、bFGF(70.08±6.87)ng/L、TGF-β1(9.08±0.91)μg/L,均高于B组的(102.35±13.11)ng/L、(65.33±6.37)ng/L、(8.09±0.83)μg/L,差异均有统计学意义(均P<0.05);两组皮瓣外观总优良率比较差异无统计学意义(χ^(2)=0.712,P=0.399),A组皮瓣感觉功能正常率高于B组[61.7%(29/47)比40.42%(19/47)],差异有统计学意义(χ^(2)=4.257,P=0.039);A组Holden步行功能分级情况优于B组,差异有统计学意义(Z=10.513,P=0.033)。结论应用游离股前外侧穿支皮瓣移植治疗糖尿病足的疗效优于游离旋股�Objective To explore the therapeutic effects of free anterolateral thigh perforator flap and free descending branch tissue flap of lateral circumflex femoral artery transplantation combined with vacuum sealing drainage in the treatment of diabetic foot.Methods A total of 94 diabetic foot patients treated at the Second Affiliated Hospital of Air Force Medical University from January 2018 to March 2023 were prospectively selected as the research subjects.They were divided into two groups,group A and B,using the random number table method.In group A,47 patients received free anterolateral thigh perforator flap transplantation,including 24 males and 23 females,aged(53.26±11.52)years,the wounds ranged from 4.2 cm×5.4 cm to 8.3 cm×10.2 cm,and the lesions were distributed at dorsum of foot in 15 cases,ankle in 18 cases,and heel in 14 cases.In group B,47 patients received free descending branch tissue flap of lateral circumflex femoral artery transplantation,including 26 males and 21 females,aged(51.34±10.89)years,the wounds ranged from 3.5 cm×4.5 cm to 7.5 cm×9.5 cm,and the lesions were distributed at dorsum of foot in 17 cases,ankle in 16 cases,and heel in 14 cases.Both groups underwent debridement with vacuum sealing drainage before surgery.The efficacy,wound healing,growth cytokines in the wound area[vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),and transforming growth factorβ1(TGFβ1)],flap sensory function,and walking ability(evaluated by Holden's Functional Ambulation Classification Scale)were compared between the two groups.t testχ^(2) test,and rank sum test were used.Results Six months after treatment,the total effective rate of group A was higher than that of group B[97.87%(46/47)vs.87.23%(41/47)],with a statistically significant difference(χ^(2)=3.859,P=0.049).The wound healing time[(28.98±4.49)d],hospital stay[(18.98±5.36)d],and granulation tissue formation time[(21.58±4.22)d]in group A were shorter than those in group B[(31.38±4.76)d,(22.38±6.42)d,and(23.65±4.59

关 键 词：糖尿病足 股前外侧穿支皮瓣 旋股外侧动脉降支 组织瓣 移植 封闭负压引流 

分 类 号：R587.2[医药卫生—内分泌] R658.3[医药卫生—内科学]