微创胫骨横向骨搬移术治疗糖尿病足的临床效果  

Effect of minimally invasive transverse tibial bone transfer in the treatment of diabetic foot

作　　者：丁凯[1] 王媛 戴小宇 许晨阳 张益舸 丁文鸽[1] Ding Kai;Wang Yuan;Dai Xiaoyu;Xu Chenyang;Zhang Yige;Ding Wenge(Changzhou First People's Hospital Traumatic Orthopaedics,Department,Changzhou 213000,China;Changzhou First People's Hospital Ultrasound Diagnosis Department,Changzhou 213000)

机构地区：[1]常州市第一人民医院创伤骨科,常州213000 [2]常州市第一人民医院超声诊断科,常州213000

出　　处：《中华骨科杂志》2024年第16期1093-1103,共11页Chinese Journal of Orthopaedics

基　　金：江苏省卫健委面上项目(M2021070);常州市卫健委科技项目(QN202102)。

摘　　要：目的探讨微创胫骨横向骨搬移治疗糖尿病足的临床疗效。方法回顾性分析2019年1月至2022年12月常州市第一人民医院创伤骨科收治的糖尿病足患者82例,糖尿病足Wagner分级2级12例、3级50例、4级20例。按手术方式分为骨搬移组45例,男29例、女16例,年龄(65.27±10.74)岁(范围44~87岁),行微创胫骨横向骨搬移联合局部清创治疗;非骨搬移组37例,男26例、女11例,年龄(66.05±11.08)岁(范围44~86岁),行局部清创治疗。比较两组患者性别、年龄、Wagner分级、患肢体表温度差、术前及术后1个月患肢部位疼痛视觉模拟评分(visual analogue scale,VAS)、术后1个月创面愈合率、术后1年患足复发或再发率,并比较不同Wagner分级的临床效果。结果两组性别、年龄、Wagner分级及术前VAS的差异无统计学意义(P>0.05);82例均获得随访,随访时间为(14.23±1.20)个月。骨搬移组在术前1天和术后第1天的患肢皮肤温度差为(6.01±0.28)℃,较非骨搬移组的(1.93±0.31)℃高,差异有统计学意义(P<0.05);术后1个月骨搬移组VAS为(2.18±0.58)分,低于非骨搬移组的(5.41±0.93)分,且骨搬移组手术前后VAS差为(4.80±1.24)分,降低幅度大于非骨搬移组的(1.62±1.48)分,差异均有统计学意义(P<0.05)。骨搬移组术后1个月创面愈合率为98.78%±2.17%,非骨搬移组愈合率为52.57%±6.41%;术后1年骨搬移组双下肢溃疡未发现复发或再发,非骨搬移组复发率为86%(32/37),差异有统计学意义(P<0.05)。Wagner分级2、3、4级术前VAS的差异无统计学意义(P>0.05)。Wagner 2、3、4级骨搬移组患者术后1个月VAS、VAS下降幅度、手术前后患肢皮肤温度差、术后1个月局部创面愈合率、术后12个月下肢溃疡复发或再发率的差异有统计学意义(P<0.05)。结论胫骨微创横向骨搬移联合局部精准清创,可以提高糖尿病足溃疡的愈合率,改善患肢末梢微循环,减轻患肢疼痛,降低糖尿病足溃疡的复发再发率。ObjectiveTo investigate the precautions and clinical effects of minimally invasive lateral bone transfer of tibia in the treatment of diabetic foot.MethodsA retrospective analysis was performed on 82 patients with diabetic foot admitted to the Trauma Department of Changzhou First People's Hospital from January 2019 to December 2022.According to the Wagner grade of diabetic foot,there were 12 cases of grade 2,50 cases of grade 3,and 20 cases of grade 4.According to the surgical method,45 patients were divided into bone transfer group.There were 29 males and 16 females,with an average age of 65.27±10.74 years(ranging from 44-87 years),who underwent minimally invasive bone transfer of tibia combined with local debridement treatment.In the non-bone transfer group,there were 37 cases(26 males and 11 females)with an average age of 66.05±11.08 years(ranging from 44 to 86 years),who were treated with local debridement.Gender,age,Wagner grade,surface temperature difference of the affected limb,visual analogue scale(VAS)score of the affected limb before and 1 month after surgery,wound healing rate 1 month after surgery,and recurrence rate of the affected foot 1 year after surgery were compared between the two groups.Outcomes of the cases of different Wagner grades were compared.ResultAll 82 patients were followed up for 14.23±1.20 months.There was no significant difference in gender,age,Wagner grade and preoperative VAS between the two groups(P>0.05).The skin temperature of the affected limb before and after surgery in the bone transfer group was significantly higher than that in the non-bone transfer group 1.93±0.31℃(P<0.05),and the VAS of the bone transfer group was 2.18±0.58 points 1 month after surgery,which was lower than that in the non-bone transfer group of 5.41±0.93.The VAS difference before and after surgery in the bone transfer group was 4.80±1.24 points,which was greater than that in the non-bone transfer group of 1.62±1.48 points with significant difference(P<0.05).The wound healing rate was over 98.

关 键 词：糖尿病足 截骨术 清创术 胫骨横向骨搬移 

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